Provider Demographics
NPI:1639476252
Name:KOPYTA INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:KOPYTA INTERNAL MEDICINE, PC
Other - Org Name:BARBARA KUCEWICZ-KOPYTA, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ELZBIETA
Authorized Official - Last Name:KUCEWICZ-KOPYTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-891-4577
Mailing Address - Street 1:312 SAND MTN DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-2330
Mailing Address - Country:US
Mailing Address - Phone:256-891-4577
Mailing Address - Fax:256-891-4919
Practice Address - Street 1:312 SAND MTN DR SE
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-2330
Practice Address - Country:US
Practice Address - Phone:256-891-4577
Practice Address - Fax:256-891-4919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00021174261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0515-01031OtherBCBS
AL009951470Medicaid
AL0515-01031OtherBCBS
AL009951470Medicaid