| Coopercare Az, PLLC | |
|
20033 N 19th Ave Ste 111 Phoenix AZ 85027-4247 | |
| (623) 582-2355 | |
| Not Available |
| Full Name | Coopercare Az, PLLC |
|---|---|
| Speciality | Family Medicine |
| Location | 20033 N 19th Ave Ste 111, Phoenix, Arizona |
| Authorized Official Name and Position | Milissa Ann Cooper (OWNER) |
| Authorized Official Contact | 6235822355 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coopercare Az, PLLC 20033 N 19th Ave Ste 111 Phoenix AZ 85027-4247 Ph: (623) 582-2355 | Coopercare Az, PLLC 20033 N 19th Ave Ste 111 Phoenix AZ 85027-4247 Ph: (623) 582-2355 |
| NPI Number | 1922704808 |
|---|---|
| Provider Enumeration Date | 02/02/2023 |
| Last Update Date | 02/02/2023 |
| Certification Date | 02/02/2023 |
| Medicare PECOS PAC ID | 3476926643 |
|---|---|
| Medicare Enrollment ID | O20230309000451 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922704808 | NPI | - | NPPES |
| 354126 | Medicaid | AZ | |
| AZ0394570 | Other | AZ | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
| Provider Name | Milissa Ann Cooper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598752164 PECOS PAC ID: 4981666419 Enrollment ID: I20041027001235 |
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