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General NPI Number Information
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NPI Number | 1568074268
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Entity Type | Organization
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Legal Business Name | COPPERTOWER FAMILY MEDICAL CENTER
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 106 E 1ST ST
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City | CLOVERDALE
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State | CA
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Zip | 95425-3746
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Country | US
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Telephone | 707-894-4229
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Fax | 707-894-2954
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Provider Business Mailing Address
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Address Line | 106 E 1ST ST
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City | CLOVERDALE
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State | CA
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Zip | 95425-3746
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Country | US
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Telephone | 707-669-1780
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JENINE SAUNDERS
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Credential |
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Telephone | 707-669-1804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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