Provider Demographics
NPI:1659615284
Name:ANDREA KOPFLER LLC
Entity Type:Organization
Organization Name:ANDREA KOPFLER LLC
Other - Org Name:BRA LA VIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPFLER
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:985-662-5065
Mailing Address - Street 1:470 PALACE DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-6079
Mailing Address - Country:US
Mailing Address - Phone:985-662-5065
Mailing Address - Fax:
Practice Address - Street 1:470 PALACE DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-662-5065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6727750001Medicare NSC