Provider Demographics
NPI:1841012630
Name:PRINCE-COOPER, RUBEN (BS)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:PRINCE-COOPER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:RUBEN
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:11715 FOX RD STE 400-222
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8421
Mailing Address - Country:US
Mailing Address - Phone:812-841-2856
Mailing Address - Fax:
Practice Address - Street 1:11715 FOX RD STE 400-222
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-8421
Practice Address - Country:US
Practice Address - Phone:812-841-2856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator