Provider Demographics
NPI:1194935403
Name:GENERATION COVENANT HEALTHCARE
Entity type:Organization
Organization Name:GENERATION COVENANT HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MERINDA
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:CONDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-741-0268
Mailing Address - Street 1:#14 BRIERCROFT OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-3035
Mailing Address - Country:US
Mailing Address - Phone:806-795-7123
Mailing Address - Fax:806-795-7172
Practice Address - Street 1:#14 BRIERCROFT OFFICE PARK
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-3035
Practice Address - Country:US
Practice Address - Phone:806-795-7123
Practice Address - Fax:806-795-7172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0050X
TX261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical