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COOPER CLINIC PA

Ambulatory Health Care Facilities Clinic/Center Multi-Specialty

Provider NPI: 1154341931

Organization Information:
Organization Name:  COOPER CLINIC PA
Organization is not Subpart
Authorized Official:  CURTIS D RALSTON  CEO  479-274-2000

Practice Location:
6801 ROGERS AVE  FORT SMITH, AR 72903-4067 US
Tel: 479-274-2000  Fax: --

Business Mailing Address:
PO BOX 3528  FORT SMITH, AR 72913-3528 US
Tel: 479-274-2000  Fax: 479-274-2194

NPI Information:
NPI: 1154341931
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y261QM1300XAmbulatory Health Care Facilities
Clinic/Center
Multi-Specialty
ARMC-0254

Other Provider Identifiers:

IssuerNumberStateType
RR MEDICAREC5028001
105693002AR05



American Medical Association 2012 taxonomy code information

Code: 261QM1300X

Type:

Classification:



Definition:



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