Provider Demographics
NPI:1053067215
Name:COVENANT LAB SERVICES
Entity Type:Organization
Organization Name:COVENANT LAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-851-3140
Mailing Address - Street 1:401 E JACKSON ST STE 2340
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5226
Mailing Address - Country:US
Mailing Address - Phone:813-851-3140
Mailing Address - Fax:813-851-3141
Practice Address - Street 1:110 LITHIA PINECREST RD STE H, OFFICE D
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5300
Practice Address - Country:US
Practice Address - Phone:813-851-3140
Practice Address - Fax:813-851-3141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Multi-Specialty