1386849040 NPI number — COPELAND MEDICAL SERVICES

Table of content: (NPI 1386849040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386849040 NPI number — COPELAND MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COPELAND MEDICAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386849040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 DOCTORS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CELINA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-243-3860
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 DOCTORS DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CELINA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-243-3860
Provider Business Practice Location Address Fax Number:
931-243-4607
Provider Enumeration Date:
06/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COPELAND
Authorized Official First Name:
JESSIE
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
931-243-3860

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC3330 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3726598 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4088210 . This is a "BLUE CROSS BLUE SHIELD TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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