Healthcare Provider Details

I. General information

NPI: 1982512323
Provider Name (Legal Business Name): COVENANT MOBILITY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E MARKET ST APT 204
INDIANAPOLIS IN
46201-3881
US

IV. Provider business mailing address

1411 E MARKET ST APT 204
INDIANAPOLIS IN
46201-3881
US

V. Phone/Fax

Practice location:
  • Phone: 463-315-7893
  • Fax: 463-315-7893
Mailing address:
  • Phone: 463-315-7893
  • Fax: 463-315-7893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. ETHEL M SMITH
Title or Position: AUTHORIZED OFFICIAL
Credential: NONE
Phone: 463-315-7893