Provider Demographics
NPI:1518537836
Name:COVENANT WC LLC
Entity Type:Organization
Organization Name:COVENANT WC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:806-355-9595
Mailing Address - Street 1:7700 S COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73169-1418
Mailing Address - Country:US
Mailing Address - Phone:405-308-5976
Mailing Address - Fax:
Practice Address - Street 1:1000 N LEE AVE STE 4404
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1036
Practice Address - Country:US
Practice Address - Phone:806-355-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty