Provider Demographics
NPI:1497907638
Name:COVINGTON ORTHOPAEDIC & SPORTS MEDICINE CLINIC
Entity Type:Organization
Organization Name:COVINGTON ORTHOPAEDIC & SPORTS MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:DARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-892-5117
Mailing Address - Street 1:19343 SUNSHINE AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8834
Mailing Address - Country:US
Mailing Address - Phone:985-892-5117
Mailing Address - Fax:985-892-5128
Practice Address - Street 1:19343 SUNSHINE AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8834
Practice Address - Country:US
Practice Address - Phone:985-892-5117
Practice Address - Fax:985-892-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019866207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1465712Medicaid
LA4N365Medicare PIN
LA4197110001Medicare NSC