NPI |
1497940837 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider Organization Name Legal Business Name |
NOVA CENTER INC. |
The first name of the provider, if the provider
is an individual. |
Provider Other Organization Name |
SKY VUE |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Other Organization Name Type Code |
5 |
The city name in the location address of the provider being identified. |
Provider First Line Business Practice Location Address |
12604 3RD ST |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address City Name |
GRANDVIEW |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address State Name |
MO |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Postal Code |
640301616 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address Telephone Number |
8167618614 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
8167650622 |
The code designating the provider’s gender if the provider is a person. |
Provider Enumeration Date |
9/10/2007 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Last Update Date |
9/11/2007 |
|
Authorized Official Last Name |
WILLIAMS |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Authorized Official First Name |
CARY |
The first name of the authorized official. |
Authorized Official Middle Name |
L |
The middle name of the authorized official. |
Authorized Official Title or Position |
CEO |
The title or position of the authorized official. |
Authorized Official Telephone Number |
8167618614 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
320600000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
MR. |
|