Provider Demographics
NPI:1922368919
Name:COVENANT MEDICAL GROUP
Entity Type:Organization
Organization Name:COVENANT MEDICAL GROUP
Other - Org Name:COVENANT ER PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR PATIENT ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:ALBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-583-6011
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-4011
Mailing Address - Fax:989-583-2811
Practice Address - Street 1:900 COOPER AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5182
Practice Address - Country:US
Practice Address - Phone:989-583-3000
Practice Address - Fax:989-583-2811
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENANT MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty