Provider Demographics
NPI:1033498126
Name:COVENANT INFUSION CENTER,INC.
Entity Type:Organization
Organization Name:COVENANT INFUSION CENTER,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KAILESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MESURIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-585-2800
Mailing Address - Street 1:2406 BROCK ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3374
Mailing Address - Country:US
Mailing Address - Phone:956-585-2800
Mailing Address - Fax:956-585-2802
Practice Address - Street 1:2406 BROCK ST
Practice Address - Street 2:SUITE 10
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3374
Practice Address - Country:US
Practice Address - Phone:956-585-2800
Practice Address - Fax:956-585-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QI0500X
TX261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy