Provider Demographics
NPI:1518500263
Name:NOVUS PAIN & PHYSICAL MEDICINE - FLORIDA LLC
Entity Type:Organization
Organization Name:NOVUS PAIN & PHYSICAL MEDICINE - FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBOSSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:240-727-3995
Mailing Address - Street 1:157 BALTIMORE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2472
Mailing Address - Country:US
Mailing Address - Phone:240-727-3995
Mailing Address - Fax:301-722-1450
Practice Address - Street 1:7052 HAWKS HARBOR CIR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-5860
Practice Address - Country:US
Practice Address - Phone:301-722-3215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty