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General NPI Number Information
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NPI Number | 1487404570
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Entity Type | Organization
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Legal Business Name | COPPER STATE MEDICAL CENTER
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 5556 S INTEGRITY LN
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-8861
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Country | US
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Telephone | 928-514-3722
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Fax |
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Provider Business Mailing Address
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Address Line | 5556 S INTEGRITY LN
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-8861
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Country | US
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Telephone | 928-514-3722
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MS. CAROLINE STRECKER
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Credential | FNP-BC
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Telephone | 928-514-3722
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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 |
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License Number State |
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