Provider Demographics
NPI:1871269415
Name:COVENANT MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:COVENANT MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:UTTERBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-374-5119
Mailing Address - Street 1:2210 SUTHERLAND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-2337
Mailing Address - Country:US
Mailing Address - Phone:865-525-4333
Mailing Address - Fax:865-212-8879
Practice Address - Street 1:2210 SUTHERLAND AVE STE 110
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-2337
Practice Address - Country:US
Practice Address - Phone:865-525-4333
Practice Address - Fax:865-212-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies