Provider Demographics
NPI:1346581485
Name:NOVUS HEALTHCARE GROUP, LLC
Entity Type:Organization
Organization Name:NOVUS HEALTHCARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:KENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-242-9517
Mailing Address - Street 1:4004 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55384-9656
Mailing Address - Country:US
Mailing Address - Phone:612-242-9517
Mailing Address - Fax:
Practice Address - Street 1:4004 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:SPRING PARK
Practice Address - State:MN
Practice Address - Zip Code:55384-9656
Practice Address - Country:US
Practice Address - Phone:612-242-9517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty