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General NPI Number Information
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NPI Number | 1245569532
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Entity Type | Organization
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Legal Business Name | IMBER COPPINGER, D.O., LLC
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Dates
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Enumeration Date | 12/15/2009
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Last Update Date | 12/15/2009
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Provider Practice Location Address
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Address Line | 410 E STATE ST
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City | ATHENS
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State | OH
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Zip | 45701-1819
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Country | US
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Telephone | 740-594-9355
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Fax | 740-594-1110
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Provider Business Mailing Address
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Address Line | 410 E STATE ST
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City | ATHENS
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State | OH
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Zip | 45701-1819
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Country | US
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Telephone | 740-594-9355
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Fax | 740-594-1110
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | IMBER C COPPINGER
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Credential | D.O.
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Telephone | 740-594-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 34007281
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License Number State | OH
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