Provider Demographics
NPI:1285905638
Name:COVINGTON EXPRESS MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:COVINGTON EXPRESS MEDICAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DWORAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-923-3609
Mailing Address - Street 1:1117 S TYLER ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2327
Mailing Address - Country:US
Mailing Address - Phone:985-892-3360
Mailing Address - Fax:985-892-3375
Practice Address - Street 1:1117 S TYLER ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2327
Practice Address - Country:US
Practice Address - Phone:985-892-3360
Practice Address - Fax:985-892-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016750363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty