Provider Demographics
NPI:1700961166
Name:COPELAND PROSTHETICS & RESEARCH INC
Entity Type:Organization
Organization Name:COPELAND PROSTHETICS & RESEARCH INC
Other - Org Name:COPELAND PROSTHETICS & RESEARCH INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:G
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:CP, LP, FAAOP
Authorized Official - Phone:813-875-3216
Mailing Address - Street 1:8001 N DALE MABRY HWY
Mailing Address - Street 2:# 101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3290
Mailing Address - Country:US
Mailing Address - Phone:813-875-3216
Mailing Address - Fax:813-875-1426
Practice Address - Street 1:8001 N DALE MABRY HWY
Practice Address - Street 2:# 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3290
Practice Address - Country:US
Practice Address - Phone:813-875-3216
Practice Address - Fax:813-875-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPR039335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1213710001Medicare ID - Type Unspecified