1629487434 NPI number — STEPHEN BENNETT COPE JR.

Table of content: STEPHEN BENNETT COPE JR. (NPI 1629487434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629487434 NPI number — STEPHEN BENNETT COPE JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COPE
Provider First Name:
STEPHEN
Provider Middle Name:
BENNETT
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
Provider Gender Code:
M

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:
1629487434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1908 FLINT RD SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35601-6031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-340-9708
Provider Business Mailing Address Fax Number:
256-340-9624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3280 DAUPHIN ST
Provider Second Line Business Practice Location Address:
SUITE A103
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36606-4060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-350-1764
Provider Business Practice Location Address Fax Number:
256-350-7757
Provider Enumeration Date:
08/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  3816 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1003819608 . This is a "GROUP NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529917620 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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