Provider Demographics
NPI:1700390101
Name:COVERT ACTION LLC
Entity Type:Organization
Organization Name:COVERT ACTION LLC
Other - Org Name:COVERT ACTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM SPONSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:COVERT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-778-6608
Mailing Address - Street 1:12734 LINCOLN CIR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-2301
Mailing Address - Country:US
Mailing Address - Phone:515-778-6608
Mailing Address - Fax:515-265-0845
Practice Address - Street 1:1223 CENTER ST STE 22
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1016
Practice Address - Country:US
Practice Address - Phone:515-218-6125
Practice Address - Fax:515-265-0845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1404261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone