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General NPI Number Information
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NPI Number | 1629481304
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Entity Type | Organization
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Legal Business Name | GENCOV HEALTHCARE
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 14 BRIERCROFT OFFICE PARK
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City | LUBBOCK
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State | TX
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Zip | 79412-3035
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Country | US
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Telephone | 806-795-7123
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2507
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City | LUBBOCK
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State | TX
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Zip | 79408-2507
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Country | US
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Telephone | 806-741-1860
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MERINDA K CONDRA
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Credential |
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Telephone | 806-741-1860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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