NPIMap

Organization Active NPI

Covenant Medical Center

  • Cardiac Rehabilitation Clinic/Center
  • Lubbock, TX
National Provider Identifier
1548878267
Registry record updated Jul 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiac Rehabilitation Clinic/CenterTaxonomy code 261QR0404X
Legal business name
COVENANT MEDICAL CENTER
Practice address
3615 19TH
Lifestyle Centre-East Parking Garage
Lubbock, TX 79410
Phone
(806) 725-0314
NPI assigned
Jul 20, 2020
Last updated
Jul 20, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
COVENANT MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 20, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dawn Boedefeld
Title
MGR-Regulatory & Enrollment Gov PRG
Phone
(907) 212-6354

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiac Rehabilitation Clinic/Center 261QR0404X NU Primary

Addresses

Primary practice location

3615 19TH
Lifestyle Centre-East Parking Garage
Lubbock, TX 79410

Mailing address

PO Box 677044
Dallas, TX 75267-7044
Phone (806) 725-0314

Other names 1

  • COVENANT MEDICAL CENTER - LIFESTYLE CENTRE IRC Other name

National Provider Directory

National Provider Directory
Tax ID family
Covenant Medical Center3 organizations share this tax ID, including this one
Part of
Covenant Medical Center

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595203200000",
    "number": "1548878267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 677044",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752677044",
            "telephone_number": "806-725-0314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 19TH",
            "address_2": "LIFESTYLE CENTRE-EAST PARKING GARAGE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "79410",
            "telephone_number": "806-725-0314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COVENANT MEDICAL CENTER",
        "enumeration_date": "2020-07-20",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A",
        "authorized_official_last_name": "BOEDEFELD",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "MGR-REGULATORY & ENROLLMENT GOV PRG",
        "authorized_official_telephone_number": "907-212-6354"
    },
    "taxonomies": [
        {
            "code": "261QR0404X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Cardiac Facilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COVENANT MEDICAL CENTER - LIFESTYLE CENTRE IRC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lubbock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.