Provider Demographics
NPI:1346350386
Name:ELIZABETH J. COVINGTON MD, INC
Entity Type:Organization
Organization Name:ELIZABETH J. COVINGTON MD, INC
Other - Org Name:CENTER4 HEALTH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD,INC
Authorized Official - Phone:323-290-2107
Mailing Address - Street 1:3701 STOCKER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5145
Mailing Address - Country:US
Mailing Address - Phone:323-290-2107
Mailing Address - Fax:323-290-0632
Practice Address - Street 1:3701 STOCKER ST STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-5145
Practice Address - Country:US
Practice Address - Phone:323-290-2107
Practice Address - Fax:323-290-0632
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELIZABETH J. COVINGTON MD, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW406Medicare PIN