MEDICARE: RICHARD COVEY, MD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	28184	AZ

General Provider Information

NPI Number	:	1346577632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD COVEY, MD, PC

Provider Business Mailing Address
First Line	:	3155 STILLWATER DR
Second Line	:	SUITE B
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-7172
Country	:	US
Telephone Number	:	928-777-8000
Fax Number	:	928-777-8104

Provider Business Practice Location Address
First Line	:	3155 STILLWATER DR
Second Line	:	SUITE B
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-7172
Country	:	US
Telephone Number	:	928-777-8000
Fax Number	:	928-777-8104

Authorized Official
Title or Position	:	CEO
Name	:	DR. RICHARD COVEY
Credential	:	M.D.
Telephone Number	:	928-777-8000

Provider Enumeration Date	:	11/09/2009
Last Update Date	:	11/25/2009

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