MEDICARE: COVENANT MEDICAL CENTER INC

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	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477594661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENANT MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	3421 W 9TH ST
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50702-5401
Country	:	US
Telephone Number	:	319-272-7600
Fax Number	:	319-272-7597

Provider Business Practice Location Address
First Line	:	751 MAIN ST
Second Line	:
City	:	ARLINGTON
State	:	IA
Zip	:	50606-9754
Country	:	US
Telephone Number	:	563-633-6965
Fax Number	:	563-633-6985

Authorized Official
Title or Position	:	CONTROLLER
Name	:	TIMOTHY HUBER
Credential	:
Telephone Number	:	319-272-7607

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	10/10/2024

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