NPIMap

Organization Active NPI

Copper Creek Medical Inc

  • Oxygen Equipment & Supplies (DME)
  • Coeur d'Alene, ID
National Provider Identifier
1295994291
Registry record updated Apr 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X
License
LRT443 Issued in ID
Legal business name
COPPER CREEK MEDICAL INC
Practice address
2005 Ironwood Pkwy
Suite 130
Coeur D Alene, ID 83814-2465
Phone
(208) 667-3203
Fax
(208) 667-3110
NPI assigned
Jun 4, 2008
Last updated
Apr 6, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2009

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

Authorized official

Name
Alfred A Tall, RRT, RPSGT
Title
President
Phone
(206) 331-1675

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oxygen Equipment & Supplies (DME) 332BX2000X LRT443 ID Primary

Addresses

Primary practice location

2005 Ironwood Pkwy
Suite 130
Coeur D Alene, ID 83814-2465

Mailing address

2005 Ironwood Pkwy
130
Coeur D Alene, ID 83814-2465
Phone (208) 667-3203

National Provider Directory

National Provider Directory
Tax ID family
Copper Creek Medical Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2005 N Ironwood Pkwy
Ste 130
Coeur D Alene, ID 83814
Phone (208) 667-3203

NPI Registry JSON

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

{
    "created_epoch": "1212537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238976000000",
    "number": "1295994291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 IRONWOOD PKWY",
            "address_2": "130",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142465",
            "telephone_number": "208-667-3203",
            "fax_number": "208-667-3110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 IRONWOOD PKWY",
            "address_2": "SUITE 130",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142465",
            "telephone_number": "208-667-3203",
            "fax_number": "208-667-3110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPPER CREEK MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-04",
        "last_updated": "2009-04-06",
        "status": "A",
        "authorized_official_last_name": "TALL",
        "authorized_official_first_name": "ALFRED",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "206-331-1675",
        "authorized_official_credential": "RRT, RPSGT"
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "ID",
            "license": "LRT443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2009; 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.