Healthcare Provider Details

I. General information

NPI: 1346389533
Provider Name (Legal Business Name): COVINGTON OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 THOMAS MORE PARKWAY SUITE 201
CRESTVIEW HILLS KY
41017-3456
US

IV. Provider business mailing address

7900 BELFORT PARKWAY SUITE 301
JACKSONVILLE FL
32256-6978
US

V. Phone/Fax

Practice location:
  • Phone: 859-426-7111
  • Fax: 859-426-7111
Mailing address:
  • Phone: 904-517-5500
  • Fax: 904-517-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number730087
License Number StateKY

VIII. Authorized Official

Name: MR. JIM EVANGER
Title or Position: PRESIDENT
Credential:
Phone: 904-517-5500