Healthcare Provider Details

I. General information

NPI: 1821818832
Provider Name (Legal Business Name): HOMEDOC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2584 RESERVE ST
ERIE CO
80516-2505
US

IV. Provider business mailing address

PO BOX 479
ERIE CO
80516-0479
US

V. Phone/Fax

Practice location:
  • Phone: 970-391-4303
  • Fax:
Mailing address:
  • Phone: 970-391-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES SCOTT KOPEL
Title or Position: CMO
Credential: MD
Phone: 970-391-4303