Provider Demographics
NPI:1700145869
Name:COPPER CREEK MEDICAL, INC.
Entity Type:Organization
Organization Name:COPPER CREEK MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:A
Authorized Official - Last Name:TALL
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, RPSGT
Authorized Official - Phone:509-998-4309
Mailing Address - Street 1:1512 N VERCLER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1087
Mailing Address - Country:US
Mailing Address - Phone:509-465-5522
Mailing Address - Fax:509-465-2642
Practice Address - Street 1:1818 S UNION AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1953
Practice Address - Country:US
Practice Address - Phone:253-759-2700
Practice Address - Fax:253-759-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies