Provider Demographics
NPI:1376271627
Name:COPPER STAR MEDICAL SUPPLY
Entity Type:Organization
Organization Name:COPPER STAR MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILDENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:801-590-2714
Mailing Address - Street 1:132 E 13065 S STE 200
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5646
Mailing Address - Country:US
Mailing Address - Phone:801-590-2714
Mailing Address - Fax:801-463-2880
Practice Address - Street 1:2415 W ERIE DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3112
Practice Address - Country:US
Practice Address - Phone:623-303-9548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COPPER STAR MEDICAL SUPPLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies