Basic Information
| Provider Information | |||||||||
| NPI: | 1164705505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOPPES | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2854 BELL ST | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404543273 | ||||||||
| FaxNumber: | 7404543273 | ||||||||
| Practice Location | |||||||||
| Address1: | 2854 BELL ST | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404543273 | ||||||||
| FaxNumber: | 7404543273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2011 | ||||||||
| LastUpdateDate: | 08/31/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 50003385 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 0309375 | 05 | OH | MEDICAID |