1922127331 NPI number — COPAC INCORPORATED

Table of content: (NPI 1922127331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922127331 NPI number — COPAC INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COPAC INCORPORATED
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:
1922127331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4309 LAKELAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOWOOD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39232-8947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-829-2500
Provider Business Mailing Address Fax Number:
601-932-3857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4309 LAKELAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLOWOOD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39232-8947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-829-2500
Provider Business Practice Location Address Fax Number:
601-932-3857
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUGHES, JR.
Authorized Official First Name:
JERALD
Authorized Official Middle Name:
STACY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
601-829-2500

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  FS39-DADA-OP-01 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1730289802 . This is a "PHYSICIAN" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 1073679817 . This is a "NURSE PRACTITIONER" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 1801997127 . This is a "PHYSICIAN" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 1316016066 . This is a "PHYSICIAN" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 0119422 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1235270885 . This is a "COPAC INCORPORATED" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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