Provider Demographics
NPI:1427389543
Name:COOPER SURGERY, INC.
Entity Type:Organization
Organization Name:COOPER SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER THORACIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:HAYDEN
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-257-5896
Mailing Address - Street 1:10810 PARKSIDE DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934
Mailing Address - Country:US
Mailing Address - Phone:865-675-2080
Mailing Address - Fax:877-896-7807
Practice Address - Street 1:10810 PARKSIDE DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934
Practice Address - Country:US
Practice Address - Phone:865-675-2080
Practice Address - Fax:877-896-7807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41864208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1346376613OtherNPI NUMBER MARK H COOPER MD
TN1523647Medicaid
TN1346376613OtherNPI NUMBER MARK H COOPER MD
TN1523647Medicaid