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General NPI Number Information
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NPI Number | 1518215391
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Entity Type | Organization
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Legal Business Name | COPPER CREEK MEDICAL, INC.
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Dates
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Enumeration Date | 08/27/2012
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 20038 68TH AVE S SUITE 101
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City | KENT
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State | WA
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Zip | 98032-2154
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Country | US
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Telephone | 253-395-2630
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Fax | 253-395-2634
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Provider Business Mailing Address
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Address Line | 21222 30TH DR SE SUITE 210
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City | BOTHELL
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State | WA
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Zip | 98021-7019
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Country | US
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Telephone | 206-621-1982
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Fax | 425-820-0831
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALFRED TALL
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Credential |
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Telephone | 509-998-4309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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