Provider Information for 1497796783
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COVENANT MEDICAL CENTER INC
Other Names:Doing Business As:MERCYONE LAPORTE CITY PHARMACYOrganization Subpart: NO
NPI: 1497796783
Last Updated: 2024-10-10
Certification Date: 2024-10-10
Certification Date: 2024-10-10
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1497796783 | ||||||||||||
| Enumeration Date | 2006-06-09 | ||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||
| Status | Active | ||||||||||||
| Authorized Official Information | Name: TIMOTHY HUBER Title: Controller Phone: 3192727607 | ||||||||||||
| Mailing Address | 2710 SAINT FRANCIS DR SUITE 101 WATERLOO, IA 50702-5619 United States Phone: 319-272-5277 | Fax:319-272-0188 | ||||||||||||
| Primary Practice Address | 601 HIGHWAY 218 N LA PORTE CITY, IA 50651-1012 United States Phone: 319-342-3620 | Fax:319-342-3617 | ||||||||||||
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