Provider Demographics
NPI:1447208434
Name:COPLEY, CHRISTOPHER J (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:COPLEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 SWEET FLAG WAY
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-5946
Mailing Address - Country:US
Mailing Address - Phone:330-618-9944
Mailing Address - Fax:330-677-0584
Practice Address - Street 1:2855 SWEET FLAG WAY
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-5946
Practice Address - Country:US
Practice Address - Phone:330-618-9944
Practice Address - Fax:330-677-0584
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-288668367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7091249Medicaid
OH730541OtherBUCKEYE COMMUNITY HLTH PL
OH120744OtherKAISER PERMANENTE INDV #
OH100153OtherKAISER PERMANENTE GROUP #
OH000000316867OtherANTHEM BCBS INDV NUMBER
OH2080224OtherUNITED HEALTHCARE GROUP #
OH2454188Medicaid
OH34-0891295OtherEMPLOYER FEDERAL TAX ID #
OHCN1092Medicare ID - Type UnspecifiedEMPLYR RR MEDICARE GROUP#
OH2080224OtherUNITED HEALTHCARE GROUP #
OH34-0891295OtherEMPLOYER FEDERAL TAX ID #