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General NPI Number Information
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NPI Number | 1972517365
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Entity Type | Organization
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Legal Business Name | COVENANT MEDICAL CENTER
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 05/09/2025
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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
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Country | US
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Telephone | 806-725-1011
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 677044
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City | DALLAS
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State | TX
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Zip | 75267-7044
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Country | US
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Telephone | 806-725-6967
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Fax | 806-725-5356
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Authorized Official
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Title or Position | ASSISTANT SECRETARY OF ENROLLMENTS
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Name | DONALD W ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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