Covenant Medical Center Inc
Organization Active NPI Chiropractor · Waterloo, IA
NPI 1790726719 · NPPES record last updated Oct 10, 2024
Key facts
- NPI
- 1790726719
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- A05512 (IA)
- Legal business name
- COVENANT MEDICAL CENTER INC
- Practice address
- 3421 W 9TH St
Waterloo, IA 50702-5401 - Phone
- (319) 272-7600
- Fax
- (319) 272-7597
- 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 3
Corporate family (same tax ID) 14
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031111000534 | IA | Part B Supplier - Clinic/Group Practice | 0244148732 |
Receives reassigned benefits from 278 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tripoli, IA; Cedar Falls, IA; Waterloo, IA; Waverly, IA; Parkersburg, IA; Evansdale, IA; Fairbank, IA; Jesup, IA… |
National Provider Directory
- Tax ID family
- Tobert Daren MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | A05512 | IA | Yes |
Addresses
Primary practice location
3421 W 9TH St
Waterloo, IA 50702-5401
Mailing address
3421 W 9TH St
Waterloo, IA 50702-5401
Phone (319) 272-7600
Other names
- MercyOne Bluebell Road Chiropractic Care
Other providers in Waterloo, IA
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.