Organization Name:  COVENANT MEDICAL GROUP


Practice Location:
2215 NASHVILLE AVE  LUBBOCK, TX 79410 US
Tel: 806-725-4800  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	208600000X	Physicians Surgery
N	208M00000X	Physicians Hospitalist
N	207X00000X	Physicians Orthopaedic Surgery
N	208000000X	Physicians Pediatrics
N	207K00000X	Physicians Allergy & Immunology
N	207L00000X	Physicians Anesthesiology
N	207N00000X	Physicians Dermatology
N	207R00000X	Physicians Internal Medicine
N	207T00000X	Physicians Neurological Surgery
N	207V00000X	Physicians Obstetrics & Gynecology
Y	207Q00000X	Physicians Family Medicine

Other Provider Identifiers:

Issuer	Number	State	Type
BCBS TX	0038GH	TX	01
	141656201	TX	05
	G1594	NM	05
BCBS NM	NM007E61	NM	01
	A7086	NM	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin