1669893095 NPI number — COVE FAMILY HEALTHCARE

Table of content: (NPI 1669893095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669893095 NPI number — COVE FAMILY HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COVE FAMILY HEALTHCARE
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:
1669893095
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 121
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COPPERAS COVE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76522-0121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-542-2440
Provider Business Mailing Address Fax Number:
254-518-2237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1007 W HIGHWAY 190
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
COPPERAS COVE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76522-3886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-542-2440
Provider Business Practice Location Address Fax Number:
254-518-2237
Provider Enumeration Date:
01/03/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WEBB
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
D
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
254-542-2440

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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