Provider Demographics
NPI:1407170285
Name:COVENANT HEALTH SOLUTIONS OF MISSISSIPPI
Entity Type:Organization
Organization Name:COVENANT HEALTH SOLUTIONS OF MISSISSIPPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-494-3277
Mailing Address - Street 1:2504 STONEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NESBIT
Mailing Address - State:MS
Mailing Address - Zip Code:38651-8351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 NORFLEET DR STE B
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2220
Practice Address - Country:US
Practice Address - Phone:662-301-2230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory