Provider Demographics
NPI:1376674143
Name:COVENANT SURGICAL CARE LLC
Entity Type:Organization
Organization Name:COVENANT SURGICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:B
Authorized Official - Middle Name:SHARON
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-833-4166
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-0120
Mailing Address - Country:US
Mailing Address - Phone:864-833-4166
Mailing Address - Fax:864-833-5668
Practice Address - Street 1:400 PLAZA CIR STE H
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7558
Practice Address - Country:US
Practice Address - Phone:864-833-4166
Practice Address - Fax:864-833-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27503174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB0828OtherMEDCOST
SCDE8167OtherMEDICARE RR
SCGP4108Medicaid
SCDE8167OtherMEDICARE RR
SC8193Medicare PIN