Provider Demographics
NPI:1982841144
Name:COVERT CLINIC, P.A.
Entity Type:Organization
Organization Name:COVERT CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:K
Authorized Official - Last Name:COVERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-898-6940
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822-0481
Mailing Address - Country:US
Mailing Address - Phone:870-898-6940
Mailing Address - Fax:870-898-4191
Practice Address - Street 1:122 SOUTHERN DR
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-8668
Practice Address - Country:US
Practice Address - Phone:870-898-6940
Practice Address - Fax:870-898-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0730261QP2300X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR176100002Medicaid
P00056552OtherRR MEDICARE
TX203282301Medicaid
608703900OtherDEPART OF LABOR
770262101OtherMEDICAID BREASTCARE
1639100001OtherQUALCHOICE
5J865OtherBLUE CROSS
AR5G150Medicare PIN