MEDICARE: COVENANT HEALTHCARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1023489580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENANT HEALTHCARE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 575
Second Line	:
City	:	BEAVER
State	:	WV
Zip	:	25813-0575
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7489 RIGHT FLANK RD
Second Line	:	STE 300
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-3845
Country	:	US
Telephone Number	:	804-467-0662
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAMES H BLUME
Credential	:
Telephone Number	:	804-467-0662

Provider Enumeration Date	:	10/09/2015
Last Update Date	:	10/09/2015

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