Provider Demographics
NPI:1629093240
Name:COVINGTON MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:COVINGTON MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREE
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:334-222-3640
Mailing Address - Street 1:PO BOX 1608
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1227
Mailing Address - Country:US
Mailing Address - Phone:334-222-3640
Mailing Address - Fax:334-222-3660
Practice Address - Street 1:115 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5323
Practice Address - Country:US
Practice Address - Phone:334-222-3640
Practice Address - Fax:334-222-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009936874Medicaid
AL009936876Medicaid
ALI01720Medicare UPIN
ALH51385Medicare UPIN
AL009936876Medicaid
AL051533774Medicare ID - Type UnspecifiedSAMUEL GACHA, MD