Provider Demographics
NPI:1417021114
Name:KOPA LLC
Entity Type:Organization
Organization Name:KOPA LLC
Other - Org Name:KOPA PA, COAST TO COAST PHYSICIANS ALLIANCE, SAND LAKE HOSPITALISTS,
Other - Org Type:Former Legal Business Name
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 700
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4643
Mailing Address - Country:US
Mailing Address - Phone:407-352-2542
Mailing Address - Fax:844-556-8650
Practice Address - Street 1:5900 LAKE ELLENOR DR STE 700
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4643
Practice Address - Country:US
Practice Address - Phone:407-352-2542
Practice Address - Fax:844-556-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2023-12-22
Deactivation Date:2023-12-15
Deactivation Code:
Reactivation Date:2023-12-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC10648OtherAHCA
FL107434200Medicaid
FL94707OtherBLUE CROSS BLUE SHEILD
FL014482800Medicaid
FL107434200Medicaid