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General NPI Number Information
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NPI Number | 1689910440
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Entity Type | Organization
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Legal Business Name | COOPER MEDICAL LLC
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Dates
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Enumeration Date | 12/26/2012
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Last Update Date | 12/26/2012
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Provider Practice Location Address
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Address Line | 223 MAGNOLIA CT
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City | SUMMERVILLE
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State | GA
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Zip | 30747-6055
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Country | US
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Telephone | 706-266-4086
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Fax | 800-258-6025
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Provider Business Mailing Address
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Address Line | 223 MAGNOLIA CT
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City | SUMMERVILLE
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State | GA
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Zip | 30747-6055
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Country | US
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Telephone | 706-266-4086
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Fax | 800-258-6025
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Authorized Official
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Title or Position | OWNER
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Name | MR. KEVIN COOPER
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Credential |
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Telephone | 706-266-4086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 20216146522
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License Number State | GA
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