Provider Demographics
NPI:1508122250
Name:COOPER CLINIC PA
Entity Type:Organization
Organization Name:COOPER CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-274-2000
Mailing Address - Street 1:PO BOX 3528
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72913-3528
Mailing Address - Country:US
Mailing Address - Phone:479-274-2000
Mailing Address - Fax:479-274-2194
Practice Address - Street 1:2000 E WOOD ST RM 1
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:AR
Practice Address - Zip Code:72855-2621
Practice Address - Country:US
Practice Address - Phone:479-963-1516
Practice Address - Fax:479-963-2643
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOPER CLINIC PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-06
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty