Provider Demographics
NPI:1518994409
Name:THE COVINGTON CLINIC. PC
Entity Type:Organization
Organization Name:THE COVINGTON CLINIC. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINGFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:901-476-1313
Mailing Address - Street 1:PO BOX 1798 DEPT 07-49
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-1798
Mailing Address - Country:US
Mailing Address - Phone:901-476-1313
Mailing Address - Fax:901-476-1314
Practice Address - Street 1:1111 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-3236
Practice Address - Country:US
Practice Address - Phone:901-476-1313
Practice Address - Fax:901-476-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6976173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP01267Medicare UPIN