Provider Demographics
NPI:1306814389
Name:THE COVENANT GROUP PA
Entity Type:Organization
Organization Name:THE COVENANT GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-469-4244
Mailing Address - Street 1:10975 BENSON ST
Mailing Address - Street 2:STE 250
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1534
Mailing Address - Country:US
Mailing Address - Phone:913-469-4244
Mailing Address - Fax:913-469-1939
Practice Address - Street 1:8929 PARALLEL PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1689
Practice Address - Country:US
Practice Address - Phone:913-596-4180
Practice Address - Fax:913-596-4797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSJ670000Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER