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Organization

COVENANT HEALTHCARE LAB

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. PAT E OWEN (EX DIRECTOR OF ADMINISTRATION)
(352) 536-9270
Entity
Organization

Contact information

Practice address
3824 E US HIGHWAY 90, LAKE CITY, FL 32055-1407
(386) 719-9915
Mailing address
4290 S HWY 27, SUITE 201, CLERMONT, FL 34711-8066
(352) 536-9270
(352) 536-9279

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
AL320
MEDICARE PTAN
FL
Enumeration date
01/28/2008
Last updated
03/19/2014
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