Healthcare Provider Details

I. General information

NPI: 1982841144
Provider Name (Legal Business Name): COVERT CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 SOUTHERN DR
ASHDOWN AR
71822-8668
US

IV. Provider business mailing address

PO BOX 481
ASHDOWN AR
71822-0481
US

V. Phone/Fax

Practice location:
  • Phone: 870-898-6940
  • Fax: 870-898-4191
Mailing address:
  • Phone: 870-898-6940
  • Fax: 870-898-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberE-0730
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberE-0730
License Number StateAR

VIII. Authorized Official

Name: GEORGE K COVERT
Title or Position: SOLE OWNER
Credential: MD
Phone: 870-898-6940