Provider Demographics
NPI:1689910440
Name:COOPER MEDICAL LLC
Entity Type:Organization
Organization Name:COOPER MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-266-4086
Mailing Address - Street 1:223 MAGNOLIA CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-6055
Mailing Address - Country:US
Mailing Address - Phone:706-266-4086
Mailing Address - Fax:800-258-6025
Practice Address - Street 1:223 MAGNOLIA CT
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-6055
Practice Address - Country:US
Practice Address - Phone:706-266-4086
Practice Address - Fax:800-258-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20216146522332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies