Provider Demographics
NPI:1043850621
Name:COVENANT HEALTH MEDICAL GROUP
Entity type:Organization
Organization Name:COVENANT HEALTH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:S
Authorized Official - Last Name:JUNGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-451-6234
Mailing Address - Street 1:330 CAPE HORN RD E
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:CA
Mailing Address - Zip Code:95713-9434
Mailing Address - Country:US
Mailing Address - Phone:530-232-4646
Mailing Address - Fax:
Practice Address - Street 1:10831 COMBIE RD STE D
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8953
Practice Address - Country:US
Practice Address - Phone:530-232-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty