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General NPI Number Information
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NPI Number | 1740613231
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Entity Type | Organization
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Legal Business Name | COVENANT SURGERY ASSOCIATES
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 306 E RANDOL MILL RD STE 106
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City | ARLINGTON
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State | TX
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Zip | 76011-5841
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Country | US
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Telephone | 817-224-2292
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Fax |
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Provider Business Mailing Address
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Address Line | 3111 PASEO
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City | GRAND PRAIRIE
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State | TX
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Zip | 75054-6861
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Country | US
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Telephone | 817-224-2292
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD ALEXANDER
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Credential | MD
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Telephone | 817-224-2292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | N7387
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License Number State | TX
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