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General NPI Number Information
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NPI Number | 1407170285
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Entity Type | Organization
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Legal Business Name | COVENANT HEALTH SOLUTIONS OF MISSISSIPPI
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 120 NORFLEET DR STE B
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City | SENATOBIA
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State | MS
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Zip | 38668-2220
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Country | US
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Telephone | 662-301-2230
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Fax |
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Provider Business Mailing Address
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Address Line | 2504 STONEBROOK DR
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City | NESBIT
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State | MS
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Zip | 38651-8351
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL AFFAIRS
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Name | BRIAN REDDEN
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Credential |
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Telephone | 901-494-3277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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