Provider Demographics
NPI:1033314414
Name:COVINGTON BONE & JOINT PC
Entity Type:Organization
Organization Name:COVINGTON BONE & JOINT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-427-3034
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1216
Mailing Address - Country:US
Mailing Address - Phone:334-427-3034
Mailing Address - Fax:334-427-3949
Practice Address - Street 1:848 S THREE NOTCH ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5320
Practice Address - Country:US
Practice Address - Phone:334-426-3034
Practice Address - Fax:334-427-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1487655148OtherINDIVIDUAL PROVIDER NPI
AL000026348Medicare PIN
AL1487655148OtherINDIVIDUAL PROVIDER NPI