Provider Demographics
NPI:1962270538
Name:COVALENT LABORATORIES LLC
Entity type:Organization
Organization Name:COVALENT LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-995-0202
Mailing Address - Street 1:8000 INNOVATION PARK DRIVE
Mailing Address - Street 2:BUILDING 3100 ROOM 199
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70820-7400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8000 INNOVATION PARK DRIVE
Practice Address - Street 2:BUILDING 3100 ROOM 199
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70820-7400
Practice Address - Country:US
Practice Address - Phone:225-578-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory