Basic Information
| Provider Information | |||||||||
| NPI: | 1689631194 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COVERT | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 VILLAGE SQ | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HAZELWOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630421817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147319675 | ||||||||
| FaxNumber: | 3147312522 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 VILLAGE SQ | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HAZELWOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630421817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147319675 | ||||||||
| FaxNumber: | 3147312522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 09/06/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | E-4518 | AR | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | AC9485447 | 05 | AR | MEDICAID |