Provider Demographics
NPI:1245569532
Name:IMBER COPPINGER, D.O., LLC
Entity Type:Organization
Organization Name:IMBER COPPINGER, D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:IMBER
Authorized Official - Middle Name:C
Authorized Official - Last Name:COPPINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-594-9355
Mailing Address - Street 1:410 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1819
Mailing Address - Country:US
Mailing Address - Phone:740-594-9355
Mailing Address - Fax:740-594-1110
Practice Address - Street 1:410 E STATE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1819
Practice Address - Country:US
Practice Address - Phone:740-594-9355
Practice Address - Fax:740-594-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007281261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care