1629093240 NPI number — COVINGTON MEDICAL ASSOCIATES, P.C.

Table of content: (NPI 1629093240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629093240 NPI number — COVINGTON MEDICAL ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COVINGTON MEDICAL ASSOCIATES, P.C.
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:
1629093240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1608
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDALUSIA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36420-1227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-222-3640
Provider Business Mailing Address Fax Number:
334-222-3660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDALUSIA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36420-5323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-222-3640
Provider Business Practice Location Address Fax Number:
334-222-3660
Provider Enumeration Date:
07/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FREE
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE
Authorized Official Telephone Number:
334-222-3640

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009936874 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051533736 . This is a "MARIA GACHA MD" identifier , issued by the state of ( AL ) . This identifiers is of the category "MEDICARE ID-TYPE UNSPECIFIED".
  • Identifier: I01720 , issued by the state of ( AL ) . This identifiers is of the category "MEDICARE UPIN".
  • Identifier: H51385 , issued by the state of ( AL ) . This identifiers is of the category "MEDICARE UPIN".
  • Identifier: 009936876 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051533774 . This is a "SAMUEL GACHA, MD" identifier , issued by the state of ( AL ) . This identifiers is of the category "MEDICARE ID-TYPE UNSPECIFIED".