Healthcare Provider Details

I. General information

NPI: 1578951455
Provider Name (Legal Business Name): COVENANT ADVANCED PRIMARY CARE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 CATHERINE LN SUITE F
GRASS VALLEY CA
95945-5756
US

IV. Provider business mailing address

200 S VIRGINIA ST STE 800
RENO NV
89501-2409
US

V. Phone/Fax

Practice location:
  • Phone: 888-966-2398
  • Fax: 888-966-2398
Mailing address:
  • Phone: 888-966-2398
  • Fax: 888-966-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT W PERRENOD
Title or Position: CEO
Credential: DNP
Phone: 888-966-2398