Provider Demographics
NPI:1649247255
Name:COVENANT FAMILY MEDICINE
Entity type:Organization
Organization Name:COVENANT FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-981-0825
Mailing Address - Street 1:3110 HIGHLAND RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-4505
Mailing Address - Country:US
Mailing Address - Phone:724-981-0825
Mailing Address - Fax:724-981-4074
Practice Address - Street 1:3110 HIGHLAND RD
Practice Address - Street 2:SUITE 203
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-4505
Practice Address - Country:US
Practice Address - Phone:724-981-0825
Practice Address - Fax:724-981-4074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY265526OtherHEALTH AMERICA/HEALTH ASS
PADB2902OtherRAIL ROAD/ MEDICARE
PADB2902OtherRAIL ROAD/ MEDICARE
PA075560Medicare ID - Type UnspecifiedPA/MEDICARE