1922090836 NPI number — GEORGE K COVERT MD

Table of content: GEORGE K COVERT MD (NPI 1922090836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922090836 NPI number — GEORGE K COVERT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COVERT
Provider First Name:
GEORGE
Provider Middle Name:
K
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:
1922090836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 SOUTHERN DR
Provider Second Line Business Mailing Address:
PO BOX 481
Provider Business Mailing Address City Name:
ASHDOWN
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71822-3360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-898-6940
Provider Business Mailing Address Fax Number:
870-898-4191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 SOUTHERN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHDOWN
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71822-8668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-898-6940
Provider Business Practice Location Address Fax Number:
870-898-4191
Provider Enumeration Date:
08/17/2005

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: 207Q00000X , with the licence number:  E0730 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 203282301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 770262101 . This is a "BREAST CARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 128201001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 608703900 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5J865 . This is a "BLUE CROSS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 1639100001 . This is a "QUAL CHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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