MEDICARE: COPPOCK SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1235090309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COPPOCK SERVICES, LLC

Provider Business Mailing Address
First Line	:	1837 COMMONS NORTH DR
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35406-3700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1837 COMMONS NORTH DR
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35406-3700
Country	:	US
Telephone Number	:	205-399-6901
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEVEN COPPOCK
Credential	:	MD
Telephone Number	:	989-284-0560

Provider Enumeration Date	:	11/19/2025
Last Update Date	:	11/19/2025

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