Provider Demographics
NPI:1093767162
Name:COVINGTON INDEPENDENT VOLUNTEER FIRE CO
Entity Type:Organization
Organization Name:COVINGTON INDEPENDENT VOLUNTEER FIRE CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:M
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-842-4130
Mailing Address - Street 1:452 DALEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:COVINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18444-7835
Mailing Address - Country:US
Mailing Address - Phone:570-842-4130
Mailing Address - Fax:570-842-9458
Practice Address - Street 1:452 DALEVILLE HWY
Practice Address - Street 2:
Practice Address - City:COVINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18444-7835
Practice Address - Country:US
Practice Address - Phone:570-842-4130
Practice Address - Fax:570-842-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2385294OtherAETNA
PA20017017OtherAMERIHEALTH MERCY HEALTH PLAN
PA0017651240002Medicaid
PA=========001OtherTRICARE
PA027962Medicare PIN
PA=========001OtherTRICARE