Provider Demographics
NPI:1073502381
Name:COVENANT HEALTH SYSTEM
Entity type:Organization
Organization Name:COVENANT HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MATANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-725-8691
Mailing Address - Street 1:4709 66TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-4841
Mailing Address - Country:US
Mailing Address - Phone:806-725-8400
Mailing Address - Fax:806-725-8463
Practice Address - Street 1:5828 SEBASTIAN PL
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2229
Practice Address - Country:US
Practice Address - Phone:210-558-9606
Practice Address - Fax:210-558-6934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007300251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
679002Medicare ID - Type Unspecified