Provider Demographics
NPI:1992880355
Name:L HUMBERTO COVARRUBIAS MD PC
Entity type:Organization
Organization Name:L HUMBERTO COVARRUBIAS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEOPOLDO
Authorized Official - Middle Name:HUMBERTO
Authorized Official - Last Name:COVARRUBIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-965-6406
Mailing Address - Street 1:497 E COLUMBIA AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015
Mailing Address - Country:US
Mailing Address - Phone:269-965-6406
Mailing Address - Fax:269-965-6138
Practice Address - Street 1:497 E COLUMBIA AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015
Practice Address - Country:US
Practice Address - Phone:269-965-6406
Practice Address - Fax:269-965-6138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILC0391102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
26003076OtherMEDICARE RR
MI1732983Medicaid
1530062OtherPHP
1530062OtherMEDICAID PHP
MI2601300171OtherBLUE CROSS BLUE SHIELD
MI2601300171OtherBLUE CARE NETWORK
=========00OtherCG HMO
A76558Medicare UPIN
MI1732983Medicaid