Provider Demographics
NPI:1891978540
Name:COVENANT BIRTH CENTER, LLC
Entity Type:Organization
Organization Name:COVENANT BIRTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:803-794-5889
Mailing Address - Street 1:1900 SUNSET BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-5932
Mailing Address - Country:US
Mailing Address - Phone:803-794-5889
Mailing Address - Fax:
Practice Address - Street 1:1900 SUNSET BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-5932
Practice Address - Country:US
Practice Address - Phone:803-794-5889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCBC-006261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing