Provider Demographics
NPI:1386231405
Name:COVENANT PRIMARY CARE LLC
Entity type:Organization
Organization Name:COVENANT PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-496-3542
Mailing Address - Street 1:134 MESA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-9148
Mailing Address - Country:US
Mailing Address - Phone:830-496-3542
Mailing Address - Fax:830-496-4157
Practice Address - Street 1:134 MESA DEL SOL
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-9148
Practice Address - Country:US
Practice Address - Phone:830-496-3542
Practice Address - Fax:830-496-4157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty