Organization
COVENANT CLINIC, P. A.
Active
Organization
COVENANT CLINIC, P. A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THELLIE RUPERT AINSLEY JR. M. D. (PRESIDENT)
(919) 774-4163
Entity
Organization
Contact information
Practice address
7953 VILLANOW DR, SANFORD, NC 27332-7595
(919) 774-4163
Mailing address
PO BOX 2427, SANFORD, NC 27331-2427
(919) 774-4163
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25545
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5950617
—
NC
01
—
DN4531
PALMETTO GBA RAILROAD MEDICARE
NC
Enumeration date
04/03/2007
Last updated
03/16/2009
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