Basic Information
| Provider Information | |||||||||
| NPI: | 1316970924 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COPPERVIEW MEDICAL CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3556 W 9800 S | ||||||||
| Address2: | 101 | ||||||||
| City: | SOUTH JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840953211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013529500 | ||||||||
| FaxNumber: | 8013529502 | ||||||||
| Practice Location | |||||||||
| Address1: | 3556 W 9800 S | ||||||||
| Address2: | 101 | ||||||||
| City: | SOUTH JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840953211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015679780 | ||||||||
| FaxNumber: | 8015679826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEI | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 8012601919 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.