Provider Demographics
NPI:1437140647
Name:NOVA NEUROSURGICAL, P A
Entity Type:Organization
Organization Name:NOVA NEUROSURGICAL, P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-272-4578
Mailing Address - Street 1:PO BOX 4428
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27404-4428
Mailing Address - Country:US
Mailing Address - Phone:336-272-4578
Mailing Address - Fax:336-272-5931
Practice Address - Street 1:1130 N CHURCH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1008
Practice Address - Country:US
Practice Address - Phone:336-272-4578
Practice Address - Fax:336-272-5931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902400Medicaid
NC02400OtherBLUE CROSS
NC8902400Medicaid
NC230100Medicare ID - Type Unspecified