1992880355 NPI number — L HUMBERTO COVARRUBIAS MD PC

Table of content: (NPI 1992880355)

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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