Provider Demographics
NPI:1508589714
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/COMP
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILDENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-590-2714
Mailing Address - Street 1:4030 E BELL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2150
Mailing Address - Country:US
Mailing Address - Phone:602-833-7586
Mailing Address - Fax:
Practice Address - Street 1:4030 E BELL RD STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2150
Practice Address - Country:US
Practice Address - Phone:602-833-7586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies