Healthcare Provider Details

I. General information

NPI: 1700238318
Provider Name (Legal Business Name): COPPER SPRINGS HOSPITAL PHYSICIAN GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10550 W MCDOWELL RD
AVONDALE AZ
85392-4864
US

IV. Provider business mailing address

101 S 5TH ST
LOUISVILLE KY
40202-3157
US

V. Phone/Fax

Practice location:
  • Phone: 480-565-3035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: GREG MILLER
Title or Position: EVO - CFO
Credential:
Phone: 412-588-3546