MEDICARE: COVENANT HEALTH SYSTEM

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	251E00000X	Home Health Agency	007008	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619966207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENANT HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	4709 66TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79414-4841
Country	:	US
Telephone Number	:	806-725-8400
Fax Number	:	806-725-8463

Provider Business Practice Location Address
First Line	:	1308 TEASLEY LN
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-7946
Country	:	US
Telephone Number	:	940-382-1011
Fax Number	:	940-383-3435

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MR. SAM MATANI
Credential	:
Telephone Number	:	806-725-8691

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	08/04/2008

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Directions to “COVENANT HEALTH SYSTEM ” Practice Location

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