Provider Demographics
NPI:1376134650
Name:KOPA HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:KOPA HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIEGASIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-216-0101
Mailing Address - Street 1:5900 LAKE ELLENOR DR STE 700C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4618
Mailing Address - Country:US
Mailing Address - Phone:407-352-2542
Mailing Address - Fax:
Practice Address - Street 1:5900 LAKE ELLENOR DR STE 700C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4618
Practice Address - Country:US
Practice Address - Phone:407-352-2542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service