Provider Demographics
NPI:1790057818
Name:COVENANT ACCESS & MOBILITY SYSTEMS, INC.
Entity Type:Organization
Organization Name:COVENANT ACCESS & MOBILITY SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FANCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-594-3384
Mailing Address - Street 1:756 HILLIARD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-4329
Mailing Address - Country:US
Mailing Address - Phone:513-594-3384
Mailing Address - Fax:
Practice Address - Street 1:756 HILLIARD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506-4329
Practice Address - Country:US
Practice Address - Phone:513-594-3384
Practice Address - Fax:937-717-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-05
Last Update Date:2012-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2714272Medicaid
OH1201041Medicaid