1699106781 NPI number — COPPERTOWER FAMILY MEDICAL CENTER

Table of content: (NPI 1699106781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699106781 NPI number — COPPERTOWER FAMILY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COPPERTOWER FAMILY MEDICAL CENTER
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:
ALEXANDER VALLEY HEALTHCARE
Provider Other Organization Name Type Code:
3
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:
1699106781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 E 1ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLOVERDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95425-3746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-669-1780
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLOVERDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95425-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-894-4229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SAUNDERS
Authorized Official First Name:
JENINE
Authorized Official Middle Name:
ROSE
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
707-669-1804

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  110000318 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com