MEDICARE: COPELAND MEDICAL INC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1548680564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COPELAND MEDICAL INC

Provider Business Mailing Address
First Line	:	PO BOX 28946
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710
Country	:	US
Telephone Number	:	559-228-5400
Fax Number	:	559-224-1825

Provider Business Practice Location Address
First Line	:	7145 N CHESTNUT AVE STE 101
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-0359
Country	:	US
Telephone Number	:	559-299-1178
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LEE COPELAND
Credential	:	MD
Telephone Number	:	559-228-4311

Provider Enumeration Date	:	04/17/2014
Last Update Date	:	04/17/2014

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