1134142011 NPI number — FLOYD L COVEY SR. PHD

Table of content: FLOYD L COVEY SR. PHD (NPI 1134142011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134142011 NPI number — FLOYD L COVEY SR. PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COVEY
Provider First Name:
FLOYD
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
SR.
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134142011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 69
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLIERVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38027-0069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-854-9030
Provider Business Mailing Address Fax Number:
901-853-6020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
328 POPLAR VIEW LANE E
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
COLLIERVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-854-9030
Provider Business Practice Location Address Fax Number:
901-853-6020
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  P1552 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3685404 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com