Copac Incorporated

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

FS39-DADA-OP-01 Issued in MS

Legal business name

COPAC INCORPORATED

Practice address

4309 Lakeland Dr
Flowood, MS 39232-8947

Phone

(601) 829-2500

Fax

(601) 932-3857

NPI assigned

Mar 28, 2007

Organization subpart

No

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

Authorized official

Name

Jerald Stacy Hughes, Jr., PHD, LPC

Title

Ceo

Phone

(601) 829-2500

Specialties & licenses 1

Addresses

Other identifiers 6

Tax ID family

Copac Addiction Services3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Copac Addiction Services

  • Substance Abuse Rehabilitation Facility
  • Brandon, MS
  • NPI 1073679817
  NPD tax ID
• Copac, Inc.

  • Substance Abuse Rehabilitation Facility
  • Brandon, MS
  • NPI 1235270885
  NPD tax ID

Locations

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193702400000",
    "number": "1922127331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4309 LAKELAND DR",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392328947",
            "telephone_number": "601-829-2500",
            "fax_number": "601-932-3857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4309 LAKELAND DR",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392328947",
            "telephone_number": "601-829-2500",
            "fax_number": "601-932-3857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPAC INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2007-10-30",
        "status": "A",
        "authorized_official_last_name": "HUGHES, JR.",
        "authorized_official_first_name": "JERALD",
        "authorized_official_middle_name": "STACY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-829-2500",
        "authorized_official_credential": "PHD, LPC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MS",
            "license": "FS39-DADA-OP-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN",
            "identifier": "1730289802",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITIONER",
            "identifier": "1073679817",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN",
            "identifier": "1801997127",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN",
            "identifier": "1316016066",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0119422",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COPAC INCORPORATED",
            "identifier": "1235270885",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda H. Cook, M.D.
• John W Cook, MD
• Kellie McCarra Cook, PT
• Monica Stewart Cook, RPH
• Chad Edward Cooley, M.D.
• Mary Coppola
• Corner Clinic Urgent Care LLC
• Cox Dental PA
• Adraine Marie Cox, FNP
• Kathryn Dooley Cox

• All providers in Flowood, MS
• Substance Abuse Rehabilitation Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; 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.