Provider Demographics
NPI:1265820054
Name:COVENANT ADVANCED PRIMARY CARE SOLUTIONS
Entity Type:Organization
Organization Name:COVENANT ADVANCED PRIMARY CARE SOLUTIONS
Other - Org Name:COVENANTCARE FAMILY & URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:PERRENOD
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:888-966-2398
Mailing Address - Street 1:200 S VIRGINIA ST STE 800
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-2409
Mailing Address - Country:US
Mailing Address - Phone:888-966-2398
Mailing Address - Fax:889-662-3988
Practice Address - Street 1:152 CATHERINE LN STE F
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5756
Practice Address - Country:US
Practice Address - Phone:888-966-2398
Practice Address - Fax:888-966-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty