Provider Demographics
NPI:1790711174
Name:HENRY CASEY COVINGTON, MD, PLLC
Entity Type:Organization
Organization Name:HENRY CASEY COVINGTON, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:CASEY
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-707-1103
Mailing Address - Street 1:1602A CANTON ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1924
Mailing Address - Country:US
Mailing Address - Phone:270-886-1773
Mailing Address - Fax:270-886-2992
Practice Address - Street 1:1602A CANTON ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1924
Practice Address - Country:US
Practice Address - Phone:270-886-1773
Practice Address - Fax:270-886-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9306Medicare ID - Type Unspecified