1992880355 NPI number — L HUMBERTO COVARRUBIAS MD PC

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 1992880355 NPI number — L HUMBERTO COVARRUBIAS MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
L HUMBERTO COVARRUBIAS MD PC
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:
1992880355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
497 E COLUMBIA AVE
Provider Second Line Business Mailing Address:
SUITE 15
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-965-6406
Provider Business Mailing Address Fax Number:
269-965-6138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
497 E COLUMBIA AVE
Provider Second Line Business Practice Location Address:
SUITE 15
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-965-6406
Provider Business Practice Location Address Fax Number:
269-965-6138
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COVARRUBIAS
Authorized Official First Name:
LEOPOLDO
Authorized Official Middle Name:
HUMBERTO
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
269-965-6406

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  LC039110 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 26003076 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1732983 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1530062 . This is a "PHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1530062 . This is a "MEDICAID PHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2601300171 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2601300171 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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