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Organization

COVENANT MEDICAL CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization

Contact information

Practice address
3615 19TH ST, LUBBOCK, TX 79410
(806) 725-1011
Mailing address
PO BOX 677044, DALLAS, TX 75267-7044
(806) 725-6967
(806) 725-5356

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
261QR0200X
Radiology Clinic/Center
261QR0206X
Mammography Clinic/Center
261QX0203X
Radiation Oncology Clinic/Center
282N00000X
General Acute Care Hospital
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100395600B
KS
05
139461106
TX
05
139461107
TX
05
160265105
AR
05
48157279
CO
05
543638
AZ
05
592923
IA
01
752765566
CHAMPUS/TRICARE
05
909867400
FL
01
A227
BC/BS ACUTE
NM
05
B3151
NM
05
B3168
NM
05
COV0040N
AL
01
HH0291
BLUE CROSS
TX
05
HS44IP
AS
05
HS44OP
AS
05
XHS41253
CA
05
XHSP31253
CA
Enumeration date
07/28/2006
Last updated
05/09/2025
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