Healthcare Provider Details

I. General information

NPI: 1891086807
Provider Name (Legal Business Name): COVENTRY HEALTH CARE WORKERS COMPENSATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 EISENHOWER BLVD
TAMPA FL
33634-6346
US

IV. Provider business mailing address

PO BOX 660776
DALLAS TX
75266-0776
US

V. Phone/Fax

Practice location:
  • Phone: 813-806-2116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA HALLEY
Title or Position: IMPLEMENTATION MANAGER
Credential: RN
Phone: 813-806-2116