MEDICARE: COPPER REGIONAL PAIN SERVICES 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	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1750503439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COPPER REGIONAL PAIN SERVICES INC

Provider Business Mailing Address
First Line	:	5141 S GILA AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85746-9526
Country	:	US
Telephone Number	:	928-812-0497
Fax Number	:	520-883-3420

Provider Business Practice Location Address
First Line	:	5141 S GILA AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85746-9526
Country	:	US
Telephone Number	:	928-812-0497
Fax Number	:	520-883-3420

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT LEWIS
Credential	:	CRNA
Telephone Number	:	928-812-0497

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	06/19/2012

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