Provider Demographics
NPI:1588602981
Name:COVENANT HEALTHCARE, LLC
Entity Type:Organization
Organization Name:COVENANT HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ARLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-451-2253
Mailing Address - Street 1:PO BOX 4050
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66063-4050
Mailing Address - Country:US
Mailing Address - Phone:913-451-2253
Mailing Address - Fax:913-451-2548
Practice Address - Street 1:801 N MUR LEN RD
Practice Address - Street 2:STE 211
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-5439
Practice Address - Country:US
Practice Address - Phone:913-451-2253
Practice Address - Fax:913-451-2548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-23085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSJ87000Medicare ID - Type Unspecified