1154353456 NPI number — STEPHEN D COVINGTON MD

Table of content: STEPHEN D COVINGTON MD (NPI 1154353456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154353456 NPI number — STEPHEN D COVINGTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COVINGTON
Provider First Name:
STEPHEN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1154353456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
168 N BRENT ST
Provider Second Line Business Mailing Address:
STE 404
Provider Business Mailing Address City Name:
VENTURA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-641-6525
Provider Business Mailing Address Fax Number:
805-641-6530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
168 N BRENT ST
Provider Second Line Business Practice Location Address:
STE 404
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-641-6525
Provider Business Practice Location Address Fax Number:
805-641-6530
Provider Enumeration Date:
07/07/2006

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: 207RG0100X , with the licence number:  G25356 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CP1005 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006253560 . This is a "MEDICAL" identifier . This identifiers is of the category "OTHER".




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