Healthcare Provider Details

I. General information

NPI: 1871608216
Provider Name (Legal Business Name): COVENANT HIGH PLAINS SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 22ND STREET
LUBBOCK TX
79410-1307
US

IV. Provider business mailing address

3610 22ND STREET
LUBBOCK TX
79410-1307
US

V. Phone/Fax

Practice location:
  • Phone: 806-776-4772
  • Fax: 806-776-4777
Mailing address:
  • Phone: 806-776-4772
  • Fax: 806-776-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: SHON SANDERS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 610-644-8900