Covenant Medical Center Inc
Organization Active NPI Community/Retail Pharmacy · Waterloo, IA
NPI 1497796494 · NPPES record last updated Oct 10, 2024
Key facts
- NPI
- 1497796494
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 284 (IA)
- Legal business name
- COVENANT MEDICAL CENTER INC
- Practice address
- 2710 Saint Francis Dr
Ste 101
Waterloo, IA 50702-5619 - Phone
- (319) 272-5700
- Fax
- (319) 272-0188
- NPI assigned
- Jun 9, 2006
- Organization subpart
- No
Authorized official
- Name
- Timothy Huber
- Title
- Controller
- Phone
- (319) 272-7607
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 14
Practitioners 234
-
Baha M Abbad, MD
-
Victor Adam Abrich, M.D.
-
Eman Al-Selmie, M.D.
-
Kristi Sue Allison, CNM
-
Olanike Omotola Alonge-Obe, MD, MPH
-
Nan L Ambrosy, DNP, ARNP
-
Rachel Anne Amling, ARNP
-
Kartik Anand, MD
-
Michael R Atherley, PA-C
-
Jacqueline Frances Ator, ARNP
-
Luis Avila, MD
-
Christopher Louis Ball, PA-C
-
Kristin Anne Beermann, ARNP
-
Fatima Begic, ARNP
-
Ann F Bell, MD
-
Anke Bellinger, MD
-
Natalie Ann Bloom, ARNP, FNP-C
-
Jessica Boevers, MD
-
Robert Bryan Boyle, APRN
-
Richard L. Bremner, D.P.M.
-
Jennifer L Bryant, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111013000054 | IA | DME Supplier - Pharmacy | 0244148732 | Practice locations: Waterloo, IA |
| O20141015000916 | IA | Part B Supplier - Mass Immunization (Roster Biller Only) | 0244148732 |
2 other NPIs on this enrollment Practice locations: Jesup, IA; Waterloo, IA; La Porte City, IA |
National Provider Directory
- Tax ID family
- Tobert Daren MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 284 | IA | Yes |
Addresses
Primary practice location
2710 Saint Francis Dr
Ste 101
Waterloo, IA 50702-5619
Mailing address
2710 Saint Francis Dr
Ste 101
Waterloo, IA 50702-5619
Phone (319) 272-5700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0086330 | Medicaid | IA | |
| 2130096 | Other | PK |
Other names
- MercyOne Waterloo Pharmacy
Other providers in Waterloo, IA
- Brendan Coutu
- Covenant Medical Center Inc
- Covenant Medical Center Inc
- Covenant Medical Center Inc
- Covenant Medical Center Inc
- Covenant Medical Center Inc
- Covenant Medical Center Inc
- Covenant Medical Center Inc
- Covenant Medical Center Inc
- Covenant Medical Center Inc
All providers in Waterloo, IA · Community/Retail Pharmacy in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.