Organization
COVENANT MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN KOTHMANN (COO)
(806) 725-4800
Entity
Organization
Contact information
Practice address
2215 NASHVILLE AVE, LUBBOCK, TX 79410-1105
(806) 725-4800
(806) 723-6532
Mailing address
2215 NASHVILLE AVE, LUBBOCK, TX 79410-1105
(806) 725-5844
(806) 723-6532
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207L00000X
Anesthesiology Physician
—
—
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
208M00000X
Hospitalist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0038GH
BCBS TX
TX
05
—
141656201
—
TX
05
—
A7086
—
NM
05
—
G1594
—
NM
01
—
NM007E61
BCBS NM
NM
Enumeration date
05/23/2006
Last updated
09/23/2020
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