Healthcare Provider Details

I. General information

NPI: 1891978540
Provider Name (Legal Business Name): COVENANT BIRTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SUNSET BLVD SUITE A
WEST COLUMBIA SC
29169-5932
US

IV. Provider business mailing address

1900 SUNSET BLVD SUITE A
WEST COLUMBIA SC
29169-5932
US

V. Phone/Fax

Practice location:
  • Phone: 803-794-5889
  • Fax:
Mailing address:
  • Phone: 803-794-5889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License NumberBC-006
License Number StateSC

VIII. Authorized Official

Name: MS. LISA S. BYRD
Title or Position: EXECUTIVE DIRECTOR
Credential: LM, CPM
Phone: 803-794-5889