Organization
COVENANT COMMUNITY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ARTNEY MICHELLE JACKSON (OFFICE MANAGER)
(661) 321-9206
Entity
Organization
Contact information
Practice address
3803 UNION AVE, BAKERSFIELD, CA 93305-2400
(661) 321-9206
(661) 321-0932
Mailing address
3803 UNION AVE, BAKERSFIELD, CA 93305-2400
(661) 321-9206
(661) 321-0932
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
G41041
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G410410
—
CA
01
—
ZZZ27058Z
MEDICARE
CA
Enumeration date
09/29/2010
Last updated
02/24/2011
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