Organization
COPPER CREEK MEDICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALFRED A TALL RRT, RPSGT (PRESIDENT)
(206) 331-1675
Entity
Organization
Contact information
Practice address
2005 IRONWOOD PKWY, SUITE 130, COEUR D ALENE, ID 83814-2465
(208) 667-3203
(208) 667-3110
Mailing address
2005 IRONWOOD PKWY, 130, COEUR D ALENE, ID 83814-2465
(208) 667-3203
(208) 667-3110
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
LRT443
ID
Other
Enumeration date
06/04/2008
Last updated
04/06/2009
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