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Kooper Harrison Underwood

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

9250 N 3rd St Ste 1003, Phoenix, AZ 85020-2402

PECOS Enrollment

This provider is enrolled in PECOS as KOOPER UNDERWOOD.

Based on the most recent information from CMS, provider Kooper Harrison Underwood is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1366039125
Provider Type
Individual
Full Name
Underwood, Kooper Harrison
Gender
Male

Sole Proprietor
Yes
Enumeration Date
12/28/2020
Last Updated
6/21/2024

Contact Information

Practice Location

9250 N 3rd St Ste 1003, Phoenix, AZ 85020-2402

(214) 551-3684

Unlisted Fax

Mailing Location

9250 N 3rd St Ste 1003, Phoenix, AZ 85020-2402

(214) 551-3684

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA17869 Texas
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer

Kooper Harrison Underwood

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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