NPIMap

Organization Active NPI

Copper Ridge Medical PA

  • Clinic/Center
  • Georgetown, TX
National Provider Identifier
1750557641
Registry record updated Jun 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
G1494 Issued in TX
Legal business name
COPPER RIDGE MEDICAL PA
Practice address
7600 Highway 29 W
Ste #5
Georgetown, TX 78628-6937
Phone
(512) 930-0363
Fax
(512) 930-0371
NPI assigned
May 1, 2008
Last updated
Jun 17, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2009

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

Authorized official

Name
Ann Nolen, D.O.NPI 1144313982
Title
Owner
Phone
(512) 930-0363

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X G1494 TX Primary

Addresses

Primary practice location

7600 Highway 29 W
Ste #5
Georgetown, TX 78628-6937

Mailing address

7600 Highway 29 W
Ste #5
Georgetown, TX 78628-6937
Phone (512) 930-0363

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245196800000",
    "number": "1750557641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7600 HIGHWAY 29 W",
            "address_2": "STE #5",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786286937",
            "telephone_number": "512-930-0363",
            "fax_number": "512-930-0371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 HIGHWAY 29 W",
            "address_2": "STE #5",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786286937",
            "telephone_number": "512-930-0363",
            "fax_number": "512-930-0371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPPER RIDGE MEDICAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-01",
        "last_updated": "2009-06-17",
        "status": "A",
        "authorized_official_last_name": "NOLEN",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-930-0363",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TX",
            "license": "G1494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.