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Organization

COOPER CLINIC, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MELISSA G ASTIN (DIRECTOR, BUSINESS SERVICES)
(479) 274-2024
Entity
Organization

Contact information

Practice address
6801 ROGERS AVE, FORT SMITH, AR 72903-4067
(479) 274-2004
(479) 274-2024
Mailing address
PO BOX 3528, FORT SMITH, AR 72913-3528
(479) 274-2004
(479) 274-2024

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
MC-0254
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
110161709
AR
01
690001634
RR MEDICARE
Enumeration date
10/25/2006
Last updated
08/28/2015
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