Provider Demographics
NPI:1366582009
Name:BILLY L COOPER
Entity type:Organization
Organization Name:BILLY L COOPER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:248-669-2416
Mailing Address - Street 1:39690 W 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3909
Mailing Address - Country:US
Mailing Address - Phone:248-669-2416
Mailing Address - Fax:248-671-0922
Practice Address - Street 1:39690 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-3909
Practice Address - Country:US
Practice Address - Phone:248-669-2416
Practice Address - Fax:248-671-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI54-0-F3-4033-0OtherBLUE CROSS BLUE SHIELD
MI6013380001Medicare NSC