Provider Demographics
NPI:1750503439
Name:COPPER REGIONAL PAIN SERVICES INC
Entity Type:Organization
Organization Name:COPPER REGIONAL PAIN SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:928-812-0497
Mailing Address - Street 1:5141 S GILA AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-9526
Mailing Address - Country:US
Mailing Address - Phone:928-812-0497
Mailing Address - Fax:520-883-3420
Practice Address - Street 1:5141 S GILA AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-9526
Practice Address - Country:US
Practice Address - Phone:928-812-0497
Practice Address - Fax:520-883-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR10171Medicare UPIN
AZZ83686Medicare PIN