Basic Information
| Provider Information | |||||||||
| NPI: | 1255497764 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COVENANT HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 342 | ||||||||
| Address2: | |||||||||
| City: | FREELAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486230342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897983638 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 COOPER AVE | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486025394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895837175 | ||||||||
| FaxNumber: | 9895837173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCLURE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | MILES | ||||||||
| AuthorizedOfficialTitleorPosition: | CARDIOVASCULAR PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9895837175 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 4704171311 | MI | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.