Provider Demographics
NPI:1528099108
Name:COVEY, MARVIN II (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:COVEY
Suffix:II
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1038
Mailing Address - Country:US
Mailing Address - Phone:812-885-3201
Mailing Address - Fax:812-885-3175
Practice Address - Street 1:520 S 7TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1038
Practice Address - Country:US
Practice Address - Phone:812-885-3201
Practice Address - Fax:812-885-3175
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000178A363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000597608OtherANTHEM
INP00670398OtherRAILROAD MEDICARE
IN258190PMedicare PIN
INP00670398OtherRAILROAD MEDICARE