| Wantzy Cooper Enterprises Llc | |
|
2440 Highway 95 Ste B215 Bullhead City AZ 86442-7323 | |
| (917) 697-4065 | |
| (928) 704-1572 |
| Full Name | Wantzy Cooper Enterprises Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2440 Highway 95 Ste B215, Bullhead City, Arizona |
| Authorized Official Name and Position | Wantzy Cooper (OWNER/MEMBER MANAGER) |
| Authorized Official Contact | 9176974065 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wantzy Cooper Enterprises Llc 2440 Highway 95 Ste B215 Bullhead City AZ 86442-7323 Ph: (917) 697-4065 | Wantzy Cooper Enterprises Llc 2440 Highway 95 Ste B215 Bullhead City AZ 86442-7323 Ph: (917) 697-4065 |
| NPI Number | 1730931718 |
|---|---|
| Provider Enumeration Date | 04/03/2024 |
| Last Update Date | 06/03/2024 |
| Medicare PECOS PAC ID | 7618318643 |
|---|---|
| Medicare Enrollment ID | O20240508002684 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730931718 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Wantzy Cooper |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1942383393 PECOS PAC ID: 6002815214 Enrollment ID: I20110208000789 |
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