Provider Demographics
NPI:1972116713
Name:COOPER, HAROLD
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 COUNTY ROAD 101
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38601-9663
Mailing Address - Country:US
Mailing Address - Phone:662-832-4876
Mailing Address - Fax:
Practice Address - Street 1:790 COUNTY ROAD 101
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38601-9663
Practice Address - Country:US
Practice Address - Phone:662-832-4876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-30
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)