Provider Demographics
NPI:1912391137
Name:COVENANT HEALTH PARTNERS, INC.
Entity Type:Organization
Organization Name:COVENANT HEALTH PARTNERS, INC.
Other - Org Name:COVENANT HEALTH PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-725-0492
Mailing Address - Street 1:3615 19TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1203
Mailing Address - Country:US
Mailing Address - Phone:806-725-3454
Mailing Address - Fax:806-723-7863
Practice Address - Street 1:3615 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1203
Practice Address - Country:US
Practice Address - Phone:806-725-3454
Practice Address - Fax:806-723-7863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty