Provider Demographics
NPI:1780280941
Name:NOVATIO, PLLC
Entity type:Organization
Organization Name:NOVATIO, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-984-7557
Mailing Address - Street 1:6080 S FORT APACHE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5616
Mailing Address - Country:US
Mailing Address - Phone:702-702-9847
Mailing Address - Fax:833-989-2328
Practice Address - Street 1:6080 S FORT APACHE RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5616
Practice Address - Country:US
Practice Address - Phone:702-984-7557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOVATIO, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-11
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty