Provider Demographics
NPI:1790243111
Name:NOVACEL
Entity Type:Organization
Organization Name:NOVACEL
Other - Org Name:NOVACEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON-OMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-888-1140
Mailing Address - Street 1:4624 S HOLLADAY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7168
Mailing Address - Country:US
Mailing Address - Phone:801-438-8280
Mailing Address - Fax:801-438-8747
Practice Address - Street 1:4624 S HOLLADAY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-7168
Practice Address - Country:US
Practice Address - Phone:018-266-3113
Practice Address - Fax:801-266-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1790243111OtherNPI