COPPER RIDGE HEALTH PC (NPI# 1265030068) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265030068 |
| Entity Type | Organization |
| Organization Name | COPPER RIDGE HEALTH PC |
| Practice Address |
4290 Copper Ridge Dr Ste 100 Traverse City MI 49684-7256 |
| Practice Telephone | 3142185052 |
| Practice Fax Number | 2314218506 |
| Mailing Telephone | 3142185052 |
| Mailing Fax Number | 2314218506 |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2020-11-09 |
| Authorized Official Name | DONOVAN MISKE (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3134440167 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0200X |
Clinic/Center Specialization: Radiology |
Ambulatory Health Care Facilities |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 200 Ottawa Ave Nw, Grand Rapids, MI 495032405 | 2314090606 |
| Street Address |
4290 COPPER RIDGE DR STE 100 |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49684-7256 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124641758 | Karen Anne Paulosky | Registered Nurse | 226 S Madison St, Traverse City, MI 49684 | 2020-05-18 |
| 1891314795 | Jaclyn Elizabeth Sylvain | Student in an Organized Health Care Education/Training Program | Munson Family Practice Center, 1400 Medical Campus Drive, Traverse City, MI 49684 | 2020-04-10 |
| 1285282988 | Madelyn Drumm | Dietitian, Registered | 217 S. Madison St., Suite 3022, Traverse City, MI 49684 | 2019-08-27 |
| 1265917686 | Kacie Danielle Heading | Social Worker | 12719 S. West Bay Shore Drive, Suite 9, Traverse City, MI 49684 | 2018-10-02 |
| 1881178325 | Jacob White Ph.d., Pllc | Psychologist | 3537 W. Front Street, Suite F, Traverse City, MI 49684 | 2018-09-20 |
| 1144702572 | Constance Baab, Phd, Lmsw, Pllc | Social Worker | 3301 Veterans Drive Suite 127, Traverse City, MI 49684 | 2018-09-01 |
| 1346732880 | The Skin Cancer and Dermatology Center Plc | Dermatology | 1225 W Front St Ste 2, Traverse City, MI 49684 | 2018-05-31 |
| 1790283851 | Lisa Louise Kleyps | Massage Therapist | 3337 W. South Airport Road #2, Traverse City, MI 49684 | 2018-01-24 |
| 1114447646 | Brittany Alexandra Prior | Physical Therapist | 3899 W Front Sreet, Unit 3, Traverse City, MI 49684 | 2017-06-26 |
| 1568902963 | Jennifer Scott | Behavior Technician | 515 W 14th St Unit D, Traverse City, MI 49684 | 2017-03-03 |
| Find all providers in zip 49684 | ||||
| Taxonomy Code | 261QR0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Radiology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043705163 | Elite Medical Diagnostics LLC | Clinic/Center | 30700 Telegraph Rd Ste 1536, Bingham Farms, MI 48025-4590 | 2018-07-01 |
| 1275022980 | Bellin Health Iron Mountain Inc | Clinic/Center | 440 Woodward Ave Ste A, Iron Mountain, MI 49801-4631 | 2018-05-08 |
| 1114416906 | Bellin Health Iron Mountain Inc | Clinic/Center | 2845 Highway Us2 and 41, Suite 202, Bark River, MI 49807 | 2018-05-07 |
| 1972092831 | Bellin Health Iron Mountain Inc | Clinic/Center | 2001 Minneapolis Ave Ste D, Gladstone, MI 49837-2060 | 2018-05-07 |
| 1437676871 | Diagnostic Solutions Pllc | Clinic/Center | 29877 Telegraph Rd Ste 400b, Southfield, MI 48034-7661 | 2017-08-25 |
| 1659769867 | Pavilion Imaging, LLC | Clinic/Center | 29201 Telegraph Rd Ste L-01, Southfield, MI 48034-1301 | 2014-12-23 |
| 1194143982 | Hurley Medical Center | Clinic/Center | 5494 S Dort Hwy, Flint, MI 48507-4483 | 2014-03-31 |
| 1003105420 | Envision Diagnostic Ultrasound Imaging LLC | Clinic/Center | 2715 Seneca St, Flint, MI 48504-5106 | 2011-04-06 |
| 1174848600 | Professional Diagnostic Imagiging Pllc | Clinic/Center | 4284 Echo Rd, Bloomfield Hills, MI 48302-1943 | 2010-03-27 |
| 1649592767 | Iha of Ann Arbor PC | Clinic/Center | 4936 W Clark Rd Ste 100, Ypsilanti, MI 48197-0861 | 2010-02-16 |
| Find all providers with the same taxonomy | ||||
| City | TRAVERSE CITY |
| Zip Code | 49684 |
Please comment or provide details below to improve the information on COPPER RIDGE HEALTH PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.