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NPI Code Detail

MEDICARE: COVENANT PEDIATRICS, LLC

MEDICARE: COVENANT PEDIATRICS, LLC
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
1261QH0100XHealth Service Clinic/Center

General Provider Information

NPI Number : 1942911607
Entity Type Code : Organization
Provider Name (Legal Business Name) : COVENANT PEDIATRICS, LLC
Provider Business Mailing Address
First Line : 2409 HYDE PARK RD
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65109-4732
Country : US
Telephone Number : 573-635-6217
Fax Number : 573-635-6574
Provider Business Practice Location Address
First Line : 2409 HYDE PARK RD
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65109-4732
Country : US
Telephone Number : 573-635-6217
Fax Number : 573-635-6574
Authorized Official
Title or Position : CHIROPRACTOR / OWNER
Name : DR. SONIA MCGOWIN
Credential : DC
Telephone Number : 573-635-6217
Provider Enumeration Date : 12/13/2022
Last Update Date : 12/13/2022

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Directions to “COVENANT PEDIATRICS, LLC ” Practice Location

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