1306814389 NPI number — THE COVENANT GROUP PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306814389 NPI number — THE COVENANT GROUP PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE COVENANT GROUP PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1306814389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10975 BENSON ST
Provider Second Line Business Mailing Address:
STE 250
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66210-1534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-469-4244
Provider Business Mailing Address Fax Number:
913-469-1939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8929 PARALLEL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66112-1689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-596-4180
Provider Business Practice Location Address Fax Number:
913-596-4797
Provider Enumeration Date:
03/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOLCOMB
Authorized Official First Name:
MARK
Authorized Official Middle Name:
S
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
913-469-4244

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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