Nova Medical Center LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

14421-020 Issued in WI

Legal business name

NOVA MEDICAL CENTER LLC

Practice address

3501 W Greenfield Ave
Milwaukee, WI 53215-1445

Phone

(414) 643-8815

Fax

(414) 643-8816

NPI assigned

Mar 18, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Maiyia Vang

Title

President

Phone

(414) 643-8815

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sergio Cruz Casaclang, MD

  • Family Medicine Physician
  • Milwaukee, WI
  • NPI 1871502906
  Medicare reassignment NPD
• Arthur B. Lee, PA

  • Physician Assistant
  • Milwaukee, WI
  • NPI 1154659662
  Medicare reassignment NPD
• Carlos Castilo Tan, M.D.

  • General Practice Physician
  • Gainesville, GA
  • NPI 1215901855
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478131200000",
    "number": "1336310374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 W GREENFIELD AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532151445",
            "telephone_number": "414-643-8815",
            "fax_number": "414-643-8816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 W GREENFIELD AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532151445",
            "telephone_number": "414-643-8815",
            "fax_number": "414-643-8816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-18",
        "last_updated": "2016-11-03",
        "status": "A",
        "authorized_official_last_name": "VANG",
        "authorized_official_first_name": "MAIYIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-643-8815",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WI",
            "license": "14421-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21282200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thane J. Nothem, CRNA
• Mazen Noufal, MD
• Nourishcare Wisconsin
• Nourishing Home Healthcare LLC
• Nouvelle Care Services Inc
• Novacare Enterprise (NexStep Youth Services)
• Novacare Enterprise (Apex Home Care)
• Connor John Novack, LCSW
• Bradley Joseph Novak, PA-C; R.T.(R)(CT)
• Joseph A Novak, MD

• Primary Care Clinic/Center in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Primary Care Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.