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Organization
COOPER CLINIC PA
Active
Organization
COOPER CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CURTIS RALSTON (CEO)
(479) 274-2000
Entity
Organization
Contact information
Practice address
6801 ROGERS AVE, FORT SMITH, AR 72903-4067
(479) 274-2000
(479) 274-2194
Mailing address
PO BOX 3528, FORT SMITH, AR 72913-3528
(479) 274-2000
(479) 274-2194
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
MC-0254
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127340128
—
AR
01
—
490002759
RR MEDICARE
—
Enumeration date
10/06/2006
Last updated
09/01/2015
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