1134399298 NPI number — CHESTER D. COPEMANN, PHD, P.C.

Table of content: (NPI 1134399298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134399298 NPI number — CHESTER D. COPEMANN, PHD, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESTER D. COPEMANN, PHD, P.C.
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:
THE OFFICE OF CHESTER D. COPEMANN, PHD, P.C.
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:
1134399298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1547
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSHILL
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00851-1547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-773-5113
Provider Business Mailing Address Fax Number:
340-773-5163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#34 ALDERSVILLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHRISTIANSTED
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-773-5113
Provider Business Practice Location Address Fax Number:
340-773-5163
Provider Enumeration Date:
03/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COPEMANN
Authorized Official First Name:
CHESTER
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
340-773-5113

Provider Taxonomy Codes

  • Taxonomy code: 103TB0200X , with the licence number:  02-014-PSY , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 02-014-PSY , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC2200X , with the licence number: 02-014-PSY , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TF0200X , with the licence number: 02-014-PSY , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TH0004X , with the licence number: 02-014-PSY , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TR0400X , with the licence number: 02-014-PSY , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TS0200X , with the licence number: 02-014-PSY , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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