Active NPI
Copper Star Medical Supply
- Oxygen Equipment & Supplies (DME)
- Mesa, AZ
National Provider Identifier
1609599802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oxygen Equipment & Supplies (DME)
- Legal business name
- COPPER STAR MEDICAL SUPPLY
- Practice address
- 1155 S Power Rd Ste 111
Mesa, AZ 85206-3716 - Phone
- (602) 960-4393
- NPI assigned
- Sep 22, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sherry A Mildenberger, RT
- Title
- Director of Clinical Services/Comp
- Phone
- (801) 590-2714
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oxygen Equipment & Supplies (DME) | 332BX2000X | Primary |
Addresses
Primary practice location
1155 S Power Rd Ste 111
Mesa, AZ 85206-3716
Mailing address
1155 S Power Rd Ste 111
Mesa, AZ 85206-3716
Phone (602) 960-4393
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230705001881 | AZ | DME Supplier - Medical Supply Company With Respiratory Therapist | 3678932191 | Practice locations: Mesa, AZ |
Other NPIs with the same Medicare PAC ID 3
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Tax ID family
- Copper Star Medical Supply
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Oxygen Equipment & Supplies (DME)
- Surprise, AZ
- NPI 1124741335
-
- Oxygen Equipment & Supplies (DME)
- Tempe, AZ
- NPI 1376271627
-
- Oxygen Equipment & Supplies (DME)
- Phoenix, AZ
- NPI 1508589714
Locations
1155 S Power Rd
Ste 111
Mesa, AZ 85206
Phone (602) 960-4393
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663804800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1663804800000",
"number": "1609599802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1155 S POWER RD STE 111",
"city": "MESA",
"state": "AZ",
"postal_code": "852063716",
"telephone_number": "602-960-4393"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1155 S POWER RD STE 111",
"city": "MESA",
"state": "AZ",
"postal_code": "852063716",
"telephone_number": "602-960-4393"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COPPER STAR MEDICAL SUPPLY",
"organizational_subpart": "NO",
"enumeration_date": "2022-09-22",
"last_updated": "2022-09-22",
"certification_date": "2022-09-22",
"status": "A",
"authorized_official_last_name": "MILDENBERGER",
"authorized_official_first_name": "SHERRY",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "DIRECTOR OF CLINICAL SERVICES/COMP",
"authorized_official_telephone_number": "801-590-2714",
"authorized_official_credential": "RT"
},
"taxonomies": [
{
"code": "332BX2000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.