Copper State Hospital and Surgical

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

5596 Issued in AZ

Legal business name

COPPER STATE HOSPITAL AND SURGICAL

Practice address

2852 S Carriage LN
Mesa, AZ 85202-7801

Phone

(480) 706-9430

NPI assigned

Mar 4, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. James Herzog, CSA

Title

Owner

Phone

(480) 706-9430

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1393891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393891200000",
    "number": "1154746865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40760",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852740760",
            "telephone_number": "480-706-9430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2852 S CARRIAGE LN",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852027801",
            "telephone_number": "480-706-9430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPPER STATE HOSPITAL AND SURGICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-04",
        "last_updated": "2014-03-04",
        "status": "A",
        "authorized_official_last_name": "HERZOG",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-706-9430",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CSA"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "5596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Copper Leaf Counseling LLC
• Copper Mountain Surgical PLLC
• Copper Sage Health LLC
• Copper Star Medical Supply
• Copper State Counseling
• Copper State Laboratory Services
• Copper Village
• Mark Coppers, LPC
• Robert J. Coppola, DO
• Sofia Rita Coracides, PHARMD

• Surgical Physician Assistant in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Surgical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.