Copper Ridge Medical PA
Clinic/Center in Georgetown, TX. Organization (NPI-2).
NPI number1750557641
StatusActive
Last updated in NPPESJun 17, 2009
Details
- NPI
- 1750557641
- Entity type
- Organization (NPI-2)
- Legal business name
- Copper Ridge Medical PA
- Organization subpart
- No
- Enumeration date
- May 1, 2008
- Last updated
- Jun 17, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | G1494 | TX | Yes |
Practice location
7600 Highway 29 WSte #5
Georgetown, TX 78628-6937
Phone 512-930-0363 · Fax 512-930-0371
Mailing address
7600 Highway 29 WSte #5
Georgetown, TX 78628-6937
Phone 512-930-0363 · Fax 512-930-0371
Authorized official
Ann Nolen
Owner
5129300363
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