Provider Demographics
NPI:1386849040
Name:COPELAND MEDICAL SERVICES
Entity Type:Organization
Organization Name:COPELAND MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-243-3860
Mailing Address - Street 1:110 DOCTORS DRIVE
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TN
Mailing Address - Zip Code:38551
Mailing Address - Country:US
Mailing Address - Phone:931-243-3860
Mailing Address - Fax:
Practice Address - Street 1:110 DOCTORS DRIVE
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TN
Practice Address - Zip Code:38551
Practice Address - Country:US
Practice Address - Phone:931-243-3860
Practice Address - Fax:931-243-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDC3330OtherRAILROAD MEDICARE
TN3726598Medicaid
TN4088210OtherBLUE CROSS BLUE SHIELD TN
TN4088210OtherBLUE CROSS BLUE SHIELD TN