Healthcare Provider Details

I. General information

NPI: 1700827896
Provider Name (Legal Business Name): COVENANT MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 W 9TH ST
WATERLOO IA
50702-5401
US

IV. Provider business mailing address

3421 W 9TH ST
WATERLOO IA
50702-5401
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-8000
  • Fax: 319-272-7597
Mailing address:
  • Phone: 319-272-7600
  • Fax: 319-272-7597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number070137H
License Number StateIA

VIII. Authorized Official

Name: TIMOTHY HUBER
Title or Position: CONTROLLER
Credential:
Phone: 319-272-7607