# COOPER CLINIC PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366655623
- **Authorized official:** CURTIS RALSTON (CEO)
- **Authorized official phone:** (479) 274-2000

## Contact information

- **Practice address:** 1801 E MAIN ST, CHARLESTON, AR 72933-9254
- **Practice address phone:** (479) 274-2000
- **Practice address fax:** (479) 274-2194
- **Mailing address:** PO BOX 3528, FORT SMITH, AR 72913-3528
- **Mailing address phone:** (479) 274-2000
- **Mailing address fax:** (479) 274-2194

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MC-0254 | AR | Yes |

## Other

- **Enumeration date:** 05/07/2007
- **Last updated:** 10/20/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 141318729 | — | AR |