Provider Demographics
NPI:1194076422
Name:COVENANT MEDICAL GROUP
Entity type:Organization
Organization Name:COVENANT MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:ALBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-583-6100
Mailing Address - Street 1:600 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5375
Mailing Address - Country:US
Mailing Address - Phone:989-583-6130
Mailing Address - Fax:989-583-6003
Practice Address - Street 1:600 IRVING AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5375
Practice Address - Country:US
Practice Address - Phone:989-583-6130
Practice Address - Fax:989-583-6003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENANT MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty