Healthcare Provider Details

I. General information

NPI: 1811258536
Provider Name (Legal Business Name): COVENANT MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5570 STATE ST
SAGINAW MI
48603-3583
US

IV. Provider business mailing address

1447 N HARRISON ST
SAGINAW MI
48602-4727
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-0100
  • Fax: 989-583-0108
Mailing address:
  • Phone: 989-583-4011
  • Fax: 989-583-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. DAVID F ALBROUGH
Title or Position: DIRECTOR PATIENT ADMINISTRATION
Credential:
Phone: 989-583-6100