Provider Demographics
NPI:1457693186
Name:COVINGTON WOMENS HEALTHCARE LLC
Entity Type:Organization
Organization Name:COVINGTON WOMENS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:334-493-0781
Mailing Address - Street 1:580 W BYPASS
Mailing Address - Street 2:STE A
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-4743
Mailing Address - Country:US
Mailing Address - Phone:334-582-4496
Mailing Address - Fax:334-582-4497
Practice Address - Street 1:580 W BYPASS
Practice Address - Street 2:STE A
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-4743
Practice Address - Country:US
Practice Address - Phone:334-582-4496
Practice Address - Fax:334-582-4497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL147127Medicaid