MEDICARE: GENERATION COVENANT HEALTHCARE

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	261QF0050X	Non-Surgical Family Planning Clinic/Center
2	261QF0050X	Non-Surgical Family Planning Clinic/Center		TX

General Provider Information

NPI Number	:	1194935403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATION COVENANT HEALTHCARE

Provider Business Mailing Address
First Line	:	#14 BRIERCROFT OFFICE PARK
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79412-3035
Country	:	US
Telephone Number	:	806-795-7123
Fax Number	:	806-795-7172

Provider Business Practice Location Address
First Line	:	#14 BRIERCROFT OFFICE PARK
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79412-3035
Country	:	US
Telephone Number	:	806-795-7123
Fax Number	:	806-795-7172

Authorized Official
Title or Position	:	CEO
Name	:	MERINDA KATHRYN CONDRA
Credential	:
Telephone Number	:	806-741-0268

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	04/02/2014

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Directions to “GENERATION COVENANT HEALTHCARE ” Practice Location

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