| Covenant Pediatrics, PLLC | |
|
421 Old Riceville Rd Ste 2 Athens TN 37303-3074 | |
| (423) 744-8755 | |
| (423) 744-8568 |
| Full Name | Covenant Pediatrics, PLLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 421 Old Riceville Rd Ste 2, Athens, Tennessee |
| Authorized Official Name and Position | Omer Breeden (BUSINESS MANAGER) |
| Authorized Official Contact | 4237448755 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Covenant Pediatrics, PLLC 421 Old Riceville Rd Ste 2 Athens TN 37303-3074 Ph: (423) 744-8755 | Covenant Pediatrics, PLLC 421 Old Riceville Rd Ste 2 Athens TN 37303-3074 Ph: (423) 744-8755 |
| NPI Number | 1659670412 |
|---|---|
| Provider Enumeration Date | 03/19/2011 |
| Last Update Date | 05/23/2022 |
| Certification Date | 05/23/2022 |
| Medicare PECOS PAC ID | 5092196261 |
|---|---|
| Medicare Enrollment ID | O20220719002303 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659670412 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | MD19704 (Tennessee) | Primary |
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