Provider Demographics
NPI:1841235074
Name:NOVA URGENT & MEDICAL CARE, P.A.
Entity type:Organization
Organization Name:NOVA URGENT & MEDICAL CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-672-0095
Mailing Address - Street 1:1813 S GLENBURNIE RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5210
Mailing Address - Country:US
Mailing Address - Phone:252-672-0095
Mailing Address - Fax:252-672-9897
Practice Address - Street 1:861 BERKSHIRE RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4728
Practice Address - Country:US
Practice Address - Phone:919-934-0985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900007Medicaid
NC126UJOtherN.C BLUE CROSS
NC5900007Medicaid