Provider Demographics
NPI:1023081429
Name:COVE FAMILY PRACTICE, INC.
Entity type:Organization
Organization Name:COVE FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRON
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-224-5132
Mailing Address - Street 1:111 NASON DR
Mailing Address - Street 2:STE 101
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673-1212
Mailing Address - Country:US
Mailing Address - Phone:814-224-5132
Mailing Address - Fax:814-224-2903
Practice Address - Street 1:111 NASON DR
Practice Address - Street 2:STE 101
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673-1212
Practice Address - Country:US
Practice Address - Phone:814-224-5132
Practice Address - Fax:814-224-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015716860011Medicaid