| Copper Ridge Medical Pa | |
|
7600 Highway 29 W Ste #5 Georgetown TX 78628-6937 | |
| (512) 930-0363 | |
| (512) 930-0371 |
| Full Name | Copper Ridge Medical Pa |
|---|---|
| Speciality | Clinic/center |
| Location | 7600 Highway 29 W, Georgetown, Texas |
| Authorized Official Name and Position | Ann Nolen (OWNER) |
| Authorized Official Contact | 5129300363 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Copper Ridge Medical Pa 7600 Highway 29 W Ste #5 Georgetown TX 78628-6937 Ph: (512) 930-0363 | Copper Ridge Medical Pa 7600 Highway 29 W Ste #5 Georgetown TX 78628-6937 Ph: (512) 930-0363 |
| NPI Number | 1750557641 |
|---|---|
| Provider Enumeration Date | 05/01/2008 |
| Last Update Date | 06/17/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750557641 | NPI | - | NPPES |
| G1494 | Other | TX | PHYSICIAN STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | G1494 (Texas) | Primary |
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