Provider Demographics
NPI:1710388665
Name:GENERATION COVENANT HEALTHCARE
Entity Type:Organization
Organization Name:GENERATION COVENANT HEALTHCARE
Other - Org Name:GENERATION HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MERINDA
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:CONDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-741-0268
Mailing Address - Street 1:PO BOX 2507
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-2507
Mailing Address - Country:US
Mailing Address - Phone:806-741-0268
Mailing Address - Fax:806-741-0142
Practice Address - Street 1:14 BRIERCROFT OFFICE PARK
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-3035
Practice Address - Country:US
Practice Address - Phone:806-795-7123
Practice Address - Fax:806-795-7172
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERATION COVENANT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical