NPIMap

Organization Active NPI

Cooper Clinic PA

  • Podiatrist
  • Fort Smith, AR
National Provider Identifier
1063768901
Registry record updated Sep 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
84 Issued in AR
Legal business name
COOPER CLINIC PA
Practice address
5004 S U St
Fort Smith, AR 72903-3600
Phone
(479) 274-6700
Fax
(479) 484-4768
NPI assigned
Jul 30, 2012
Last updated
Sep 1, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Curtis Ralston
Title
Ceo
Phone
(479) 274-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 84 AR Primary

Addresses

Primary practice location

5004 S U St
Fort Smith, AR 72903-3600

Mailing address

PO Box 3528
Fort Smith, AR 72913-3528
Phone (479) 274-2000

Other identifiers 1

IdentifierTypeStateIssuer
191272716MedicaidAR

National Provider Directory

National Provider Directory
Tax ID family
Cooper Clinic Physician13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441065600000",
    "number": "1063768901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3528",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729133528",
            "telephone_number": "479-274-2000",
            "fax_number": "479-274-2194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5004 S U ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729033600",
            "telephone_number": "479-274-6700",
            "fax_number": "479-484-4768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOPER CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-30",
        "last_updated": "2015-09-01",
        "status": "A",
        "authorized_official_last_name": "RALSTON",
        "authorized_official_first_name": "CURTIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "479-274-2000"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "AR",
            "license": "84",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "191272716",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Smith, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.