Organization Name: | NOVIA CARECLINICS, LLC |
NPI Number: | 1225369721 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ERIC OLSON (PRESIDENT) |
Mailing Address: | 214 Indiana Ave Mishawaka |
State: | IN US |
Postal Code: | 465442533 |
Phone Number: | 3174727568 |
Fax Number: | 5748551565 |
NPI Enumeration Date: | 01/22/2010 |
NPI Last Update Date: | 01/22/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |