Organization Name: | COPLEY PROFESSIONAL SERVICES GROUP, INC. |
NPI Number: | 1124436332 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KEVIN J KELLEY (PRESIDENT/CEO) |
Mailing Address: | 607 Washington Highway Morrisville |
State: | VT US |
Postal Code: | 05661 |
Phone Number: | 8028887337 |
Fax Number: | 8028886040 |
NPI Enumeration Date: | 07/31/2014 |
NPI Last Update Date: | 07/22/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | 042-0012860 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VT |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |