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General NPI Number Information
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NPI Number | 1912391137
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Entity Type | Organization
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Legal Business Name | COVENANT HEALTH PARTNERS, INC.
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 3615 19TH ST
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City | LUBBOCK
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State | TX
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Zip | 79410-1203
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Country | US
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Telephone | 806-725-3454
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Fax | 806-723-7863
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Provider Business Mailing Address
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Address Line | 3615 19TH ST
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City | LUBBOCK
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State | TX
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Zip | 79410-1203
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Country | US
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Telephone | 806-725-3454
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Fax | 806-723-7863
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. JOHN GRIGSON
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Credential |
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Telephone | 806-725-0492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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