MEDICARE: COPPER STATE ORTHOPEDICS, LTD

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	207X00000X	Orthopaedic Surgery Physician	22049	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932255791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COPPER STATE ORTHOPEDICS, LTD

Provider Business Mailing Address
First Line	:	1002 E MCDOWELL RD
Second Line	:	SUITE A
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2625
Country	:	US
Telephone Number	:	602-262-2663
Fax Number	:	602-258-3008

Provider Business Practice Location Address
First Line	:	1002 E MCDOWELL RD
Second Line	:	SUITE A
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2625
Country	:	US
Telephone Number	:	602-262-2663
Fax Number	:	602-258-3008

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CHAR L MANLEY
Credential	:
Telephone Number	:	602-262-2663

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	04/21/2008

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Directions to “COPPER STATE ORTHOPEDICS, LTD ” Practice Location

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