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NPI Code Detail

MEDICARE: JOSEPH H COOPER PA

MEDICARE: JOSEPH H COOPER PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant831WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24163956OTHERTNBCBST
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386607588
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH H COOPER PA
Provider Business Mailing Address
First Line : 854 W JAMES CAMPBELL BLVD
Second Line : SUITE 303-A
City : COLUMBIA
State : TN
Zip : 38401-4659
Country : US
Telephone Number : 931-540-4255
Fax Number : 931-490-4654
Provider Business Practice Location Address
First Line : 1220 TROTWOOD AVE
Second Line : SUITE 401
City : COLUMBIA
State : TN
Zip : 38401-6433
Country : US
Telephone Number : 931-388-6550
Fax Number : 931-388-6549
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2006
Last Update Date : 04/04/2008

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Directions to “ JOSEPH H COOPER PA” Practice Location

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