Provider Demographics
NPI:1497099279
Name:CANDACE Y COVINGTON MD
Entity Type:Organization
Organization Name:CANDACE Y COVINGTON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-325-4925
Mailing Address - Street 1:218 SW 26TH AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-8251
Mailing Address - Country:US
Mailing Address - Phone:940-325-4925
Mailing Address - Fax:940-325-4955
Practice Address - Street 1:218 SW 26TH AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-8251
Practice Address - Country:US
Practice Address - Phone:940-325-4925
Practice Address - Fax:940-325-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3581208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty