Provider Demographics
NPI:1457311904
Name:COPPERFIELD OB/GYN P.L.L.C.
Entity Type:Organization
Organization Name:COPPERFIELD OB/GYN P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:GIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:704-786-7158
Mailing Address - Street 1:349 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1221
Mailing Address - Country:US
Mailing Address - Phone:704-786-7158
Mailing Address - Fax:704-786-7160
Practice Address - Street 1:349 PENNY LN
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1221
Practice Address - Country:US
Practice Address - Phone:704-786-7158
Practice Address - Fax:704-786-7160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0104VOtherBCBS
NC890104VMedicaid
NC2316738Medicare ID - Type Unspecified