1225084627 NPI number — JEFFREY A. COPOLOFF, PLLC

Table of content: (NPI 1225084627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225084627 NPI number — JEFFREY A. COPOLOFF, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY A. COPOLOFF, PLLC
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:
1225084627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14390
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85267-4390
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-934-3211
Provider Business Mailing Address Fax Number:
480-661-3990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8415 N PIMA RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85258-4480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-934-3211
Provider Business Practice Location Address Fax Number:
480-661-3990
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COPOLOFF
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/DOCTOR
Authorized Official Telephone Number:
623-934-3211

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  0355 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11178489 . This is a "CAQH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 129181 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6202669 . This is a "GHI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 2Z1833 . This is a "HEALTH NET AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 4496171 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 6624646 . This is a "CIGNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0195160 . This is a "BCBS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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