Provider Demographics
NPI:1568500742
Name:COVINGTON PIKE MEDICAL CLINIC, P.C.
Entity Type:Organization
Organization Name:COVINGTON PIKE MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-372-3200
Mailing Address - Street 1:3789 COVINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38135-2279
Mailing Address - Country:US
Mailing Address - Phone:901-372-3200
Mailing Address - Fax:901-388-9501
Practice Address - Street 1:3789 COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38135-2279
Practice Address - Country:US
Practice Address - Phone:901-372-3200
Practice Address - Fax:901-388-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704525Medicare ID - Type UnspecifiedGROUP NUMBER