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Organization

COPPER SUN ENTERPRISES, INC

Active
Other names
Copper Sun Medical Supply
Organization subpart
No

Provider details

NPI number
Authorized official
MR. GREGORY PAUL LAZARIN (CEO)
(928) 425-8540
Entity
Organization

Contact information

Practice address
157 W CEDAR ST, GLOBE, AZ 85501-2509
(928) 425-8540
(866) 679-2291
Mailing address
PO BOX 1783, CLAYPOOL, AZ 85532-1783
(928) 425-8540
(866) 679-2291

Taxonomy

Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
11022216
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11022216
AZ DEPT OF REVENUE TPT
AZ
01
AZ0274230
BCBS
AZ
Enumeration date
11/23/2005
Last updated
10/25/2011
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