Provider Demographics
NPI:1346421385
Name:BENJAMIN W. COVINGTON, M.D., P.A.
Entity Type:Organization
Organization Name:BENJAMIN W. COVINGTON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:806-236-0123
Mailing Address - Street 1:PO BOX 1868
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-1868
Mailing Address - Country:US
Mailing Address - Phone:806-236-0123
Mailing Address - Fax:
Practice Address - Street 1:5805 WINTER PARK DR
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-5345
Practice Address - Country:US
Practice Address - Phone:806-236-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0067LTOtherBLUE CROSS BLUE SHIELD
TX170802601Medicaid
TXDC3006OtherRAILROAD MEDICARE
TX0067LTOtherBLUE CROSS BLUE SHIELD
TXDC3006OtherRAILROAD MEDICARE