Provider Demographics
NPI: | 1619412376 |
---|---|
Name: | COVENANT MEDICAL CENTER, INC |
Entity Type: | Organization |
Organization Name: | COVENANT MEDICAL CENTER, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PEGGY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MAINE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 989-583-6100 |
Mailing Address - Street 1: | 1447 N HARRISON ST |
Mailing Address - Street 2: | |
Mailing Address - City: | SAGINAW |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48602-4727 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 989-583-2833 |
Mailing Address - Fax: | 989-583-1440 |
Practice Address - Street 1: | 1447 N HARRISON ST |
Practice Address - Street 2: | |
Practice Address - City: | SAGINAW |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48602-4727 |
Practice Address - Country: | US |
Practice Address - Phone: | 989-583-2833 |
Practice Address - Fax: | 989-583-1440 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-01-04 |
Last Update Date: | 2017-01-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 730061 | 207Q00000X, 207R00000X, 207VX0201X, 207X00000X, 207Y00000X, 2080P0203X, 2080P0206X, 208100000X, 208200000X, 2084N0400X, 2084N0402X, 2085R0001X, 2085R0202X, 2088P0231X, 208G00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207VX0201X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | Group - Multi-Specialty |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | Group - Multi-Specialty |
No | 2080P0206X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | Group - Multi-Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2084N0402X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | Group - Multi-Specialty |
No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 2088P0231X | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology | Group - Multi-Specialty |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty |