COVENANT MEDICAL CENTER (NPI# 1972517365) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972517365 |
| Entity Type | Organization |
| Organization Name | COVENANT MEDICAL CENTER |
| Practice Address |
3615 19th St Lubbock TX 79410 |
| Mailing Address |
3615 19th St Lubbock TX 79410-1203 |
| Practice Telephone | 8067251011 |
| Mailing Telephone | 8067256967 |
| Mailing Fax Number | 8067255356 |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2020-10-01 |
| Authorized Official Name | DONALD W ANDERSON JR. (ASSISTANT SECRETARY FOR ENROLLMENT) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR0206X |
Clinic/Center Specialization: Radiology, Mammography |
Ambulatory Health Care Facilities | ||
| N | 261QX0203X |
Clinic/Center Specialization: Oncology, Radiation |
Ambulatory Health Care Facilities | ||
| N | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities | ||
| N | 261QR0200X |
Clinic/Center Specialization: Radiology |
Ambulatory Health Care Facilities | ||
| Y | 282N00000X | General Acute Care Hospital | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 139461106 | 05 | |
| TX | 139461107 | 05 | |
| CO | 48157279 | 05 | |
| TX | BLUE CROSS | HH0291 | 01 |
| AZ | 543638 | 05 | |
| CHAMPUS/TRICARE | 752765566 | 01 | |
| NM | B3168 | 05 | |
| AS | HS44IP | 05 | |
| NM | B3151 | 05 | |
| KS | 100395600B | 05 | |
| IA | 592923 | 05 | |
| FL | 909867400 | 05 | |
| CA | XHS41253 | 05 | |
| AS | HS44OP | 05 | |
| CA | XHSP31253 | 05 | |
| AL | COV0040N | 05 | |
| AR | 160265105 | 05 | |
| NM | BC/BS ACUTE | A227 | 01 |
| Other Name | Type Code |
|---|---|
| Covenant Medical Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548878267 | Covenant Medical Center | Clinic/Center | 3615 19th, Lifestyle Centre-east Parking Garage, Lubbock, TX 79410 | 2020-07-20 |
| 1689112930 | Covenant Medical Center | Pharmacy | 3615 19th St Fl 1, Lubbock, TX 79410-1203 | 2017-02-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | COVENANT MEDICAL CENTER | 3615 19th, Lubbock, TX 79410-1203 |
| Iowa Business Entities | COVENANT MEDICAL CENTER, INC. | 3421 W 9th St, Waterloo, IA 50704 |
| Street Address |
3615 19TH ST |
| City | LUBBOCK |
| State | TX |
| Zip Code | 79410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144217100 | Thelma Wong Sutter | Specialist | 3615 19th St, Lubbock, TX 79410-1203 | 2005-10-04 |
| 1831798685 | Jacob Don Paul | Nurse Practitioner | 3615 19th St, Lubbock, TX 79410-1203 | 2020-10-22 |
| 1336778711 | Ephraim Joseph Anderson | Religious Nonmedical Practitioner | 3615 19th St, Lubbock, TX 79410-1203 | 2020-04-07 |
| 1275188229 | Emily White | Registered Nurse | 3615 19th St, Lubbock, TX 79410-1203 | 2019-08-06 |
| 1811456569 | Melinda Dixon | Nurse Practitioner | 3615 19th St, Lubbock, TX 79410-1209 | 2019-03-12 |
| 1134693880 | Alexandra D Bates | Nurse Practitioner | 3615 19th St, Lubbock, TX 79410-1203 | 2019-01-16 |
| 1790256915 | Alyssa Taylor | Pharmacist | 3615 19th St, Lubbock, TX 79410-1209 | 2018-12-16 |
| 1346723517 | Matthew E Heers | Physical Therapy Assistant | 3615 19th St, Lubbock, TX 79410-1203 | 2018-09-12 |
| 1417468992 | Tyler Little | Physician Assistant | 3615 19th St, Lubbock, TX 79410-1203 | 2017-10-23 |
| 1598294712 | David Marsh | Emergency Medicine | 3615 19th St, Lubbock, TX 79410-1203 | 2017-06-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548878267 | Covenant Medical Center | Clinic/Center | 3615 19th, Lifestyle Centre-east Parking Garage, Lubbock, TX 79410 | 2020-07-20 |
| 1669038626 | Hub City Anesthesia | Nurse Anesthetist, Certified Registered | 3416 22nd Street, Lubbock, TX 79410 | 2019-05-15 |
| 1912447418 | Lubbock Surgery Center, LLC | Clinic/Center | 3416 22nd St, Lubbock, TX 79410 | 2017-03-02 |
| 1871032698 | Lezlee Berry | Pharmacist | 3615 19th Street, Lubbock, TX 79410 | 2017-02-13 |
| 1376914101 | Matthew Cotton | Nurse Practitioner | 2424 Quaker Ave, Lubbock, TX 79410 | 2015-10-20 |
| 1841534864 | Frank Nwabugwu | Pharmacist | 4120 34th Street, Lubbock, TX 79410 | 2012-11-15 |
| 1689954794 | Dharmendra Kumar | Pediatrics | Covenant Children's Hospital, 4000 24th Street, Lubbock, TX 79410 | 2011-08-19 |
| 1518277177 | T.r.m. Rao, M.d., P.a. | Colon & Rectal Surgery | 3809 22nd Street, Suite C, Lubbock, TX 79410 | 2010-10-18 |
| 1700196672 | Hanford Consultations P.a. | Family Medicine | 4000 22nd Place Suite 100, Lubbock, TX 79410 | 2010-10-13 |
| 1336452598 | Amanda Collins | Specialist | 4801 34th Street, Lubbock, TX 79410 | 2010-07-16 |
| Find all providers in zip 79410 | ||||
| Taxonomy Code | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649401050 | Quaker Medical Lp | General Acute Care Hospital | 4302 Princeton St Unit B, Lubbock, TX 79415-1307 | 2009-08-03 |
| 1184888695 | Texas Tech University Health Sciences | General Acute Care Hospital | 4812 100th St, Lubbock, TX 79424-5702 | 2008-07-14 |
| 1013941780 | Covenant Long-term Care, Lp | General Acute Care Hospital | 3815 20th Street, Lubbock, TX 79410-1203 | 2006-07-10 |
| 1922001775 | Lubbock Heart Hospital, LLC | General Acute Care Hospital | 4810 North Loop 289, Lubbock, TX 79416-3025 | 2005-05-24 |
| 1518348747 | Covenant Rehabilitation Hospital of Lubbock LLC | General Acute Care Hospital | 4302 Princeton St, Lubbock, TX 79415-1304 | 2015-06-12 |
| 1497159966 | Tracy Lynn Newton | General Acute Care Hospital | 602 Indiana Ave, Lubbock, TX 79415-3364 | 2014-10-13 |
| 1154767580 | Lubbock Heritage Hospital, LLC | General Acute Care Hospital | 2412 50th St, Lubbock, TX 79412-2504 | 2013-05-13 |
| 1598900946 | Lubbock County Hospital District | General Acute Care Hospital | 602 Indiana Ave, Lubbock, TX 79415-3364 | 2008-12-12 |
| 1225289499 | Lubbock Heritage Hospital, LLC. | General Acute Care Hospital | 2412 50th St, Lubbock, TX 79412-2504 | 2008-10-07 |
| 1245402866 | North Quaker Hospital, Lp | General Acute Care Hospital | 4302 Princeton Street, Lubbock, TX 79415-1304 | 2008-03-25 |
| Find all providers in LUBBOCK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.