Covenant Medical Group, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

COVENANT MEDICAL GROUP, INC

Practice address

423 Medical Park Dr
Ste 100
Lenoir City, TN 37772-5640

Phone

(865) 271-6575

Fax

(865) 986-7807

NPI assigned

Aug 16, 2011

Last updated

Feb 17, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Julie G Utterback

Title

VP Financial Services

Phone

(865) 374-5119

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1313452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455667200000",
    "number": "1730468182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 CENTERPOINT BLVD",
            "address_2": "BLDG A, STE 202",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379321979",
            "telephone_number": "865-374-5200",
            "fax_number": "865-374-5201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "423 MEDICAL PARK DR",
            "address_2": "STE 100",
            "city": "LENOIR CITY",
            "state": "TN",
            "postal_code": "377725640",
            "telephone_number": "865-271-6575",
            "fax_number": "865-986-7807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-16",
        "last_updated": "2016-02-17",
        "status": "A",
        "authorized_official_last_name": "UTTERBACK",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "VP FINANCIAL SERVICES",
        "authorized_official_telephone_number": "865-374-5119",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3734041",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Lenoir City, TN
• Providers in Lenoir City, TN by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2016; 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.