| Covenant Medical Group Inc | |
|
415 Henslee Dr Dickson TN 37055-2166 | |
| (615) 441-6140 | |
| (615) 441-6190 |
| Full Name | Covenant Medical Group Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 415 Henslee Dr, Dickson, Tennessee |
| Authorized Official Name and Position | Walter Stephens (OWNER) |
| Authorized Official Contact | 6154416140 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Covenant Medical Group Inc 415 Henslee Dr Dickson TN 37055-2166 Ph: (615) 441-6140 | Covenant Medical Group Inc 415 Henslee Dr Dickson TN 37055-2166 Ph: (615) 441-6140 |
| NPI Number | 1629266994 |
|---|---|
| Provider Enumeration Date | 10/11/2007 |
| Last Update Date | 01/08/2008 |
| Medicare PECOS PAC ID | 1951482504 |
|---|---|
| Medicare Enrollment ID | O20080122000027 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629266994 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Walter E Stephens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205878220 PECOS PAC ID: 2769470855 Enrollment ID: I20040505001703 |
| Provider Name | William E Burt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154542926 PECOS PAC ID: 4880753904 Enrollment ID: I20090113000489 |
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