Organization
COVENTRY CLINIC COMPANY LLC
Active
Parent organization
COVENTRY CLINIC COMPANY LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COVENTRY CLINIC COMPANY LLC
Authorized official
DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(877) 892-9813
Entity
Organization
Contact information
Practice address
1600 E HIGH ST, POTTSTOWN, PA 19464-5008
(610) 327-7000
Mailing address
7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829
(615) 465-7043
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207ZC0500X
Cytopathology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1018109480001
—
PA
05
—
1018109480002
—
PA
01
—
1926761
BCBS
PA
01
—
1929336
BCBS
PA
Enumeration date
11/10/2006
Last updated
01/23/2008
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