Provider Demographics
NPI:1790767523
Name:COVENANT MEDICAL CENTER INC
Entity Type:Organization
Organization Name:COVENANT MEDICAL CENTER INC
Other - Org Name:VNA INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:S.
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:BSN,MS
Authorized Official - Phone:989-799-6020
Mailing Address - Street 1:500 S HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-1511
Mailing Address - Country:US
Mailing Address - Phone:989-799-6020
Mailing Address - Fax:989-799-6062
Practice Address - Street 1:500 S HAMILTON ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-1511
Practice Address - Country:US
Practice Address - Phone:989-799-6020
Practice Address - Fax:989-799-6062
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENANT MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-17
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3047566Medicaid
MI1300250001Medicare ID - Type UnspecifiedMEDICARE