Provider Demographics
NPI:1396099032
Name:COVINGTON EXPRESS MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:COVINGTON EXPRESS MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MILTENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-222-2002
Mailing Address - Street 1:75421 HIGHWAY 1081
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-2603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:360 EMERALD FOREST BLVD STE H
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5193
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:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty