| Covenant Health Medical Group | |
|
10831 Combie Rd Ste D Auburn CA 95602-8953 | |
| (530) 232-4646 | |
| Not Available |
| Full Name | Covenant Health Medical Group |
|---|---|
| Speciality | General Practice |
| Location | 10831 Combie Rd Ste D, Auburn, California |
| Authorized Official Name and Position | Brooke S Jungi (PRACTICE OPERATIONS MANAGER) |
| Authorized Official Contact | 5304516234 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Covenant Health Medical Group 330 Cape Horn Rd E Colfax CA 95713-9434 Ph: (530) 232-4646 | Covenant Health Medical Group 10831 Combie Rd Ste D Auburn CA 95602-8953 Ph: (530) 232-4646 |
| NPI Number | 1043850621 |
|---|---|
| Provider Enumeration Date | 01/10/2020 |
| Last Update Date | 04/22/2021 |
| Medicare PECOS PAC ID | 5395170054 |
|---|---|
| Medicare Enrollment ID | O20200422002974 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043850621 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Mark E Knoble |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174617799 PECOS PAC ID: 1658431192 Enrollment ID: I20081113000648 |
| Provider Name | Beverly L Meier Hanaway |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366708901 PECOS PAC ID: 1557687373 Enrollment ID: I20150312002546 |
| Provider Name | Scott Wayne Perrenod |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063523470 PECOS PAC ID: 7618288101 Enrollment ID: I20150803002140 |
| Provider Name | David J Kyle |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1952531758 PECOS PAC ID: 9638472194 Enrollment ID: I20160118000764 |
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