NPIMap

Organization Active NPI

Cooper Clinic, PA

  • Clinic/Center
  • Fort Smith, AR
National Provider Identifier
1104832708
Registry record updated Sep 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
MC-0254 Issued in AR
Legal business name
COOPER CLINIC, PA
Practice address
4600 Towson Ave
Ste 101-N
Fort Smith, AR 72901-7961
Phone
(479) 274-6900
Fax
(479) 648-3951
NPI assigned
Aug 1, 2006
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 D Ralston
Title
Ceo
Phone
(479) 274-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X MC-0254 AR Primary

Addresses

Primary practice location

4600 Towson Ave
Ste 101-N
Fort Smith, AR 72901-7961

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
136194002MedicaidAR

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441065600000",
    "number": "1104832708",
    "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": "4600 TOWSON AVE",
            "address_2": "STE 101-N",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729017961",
            "telephone_number": "479-274-6900",
            "fax_number": "479-648-3951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOPER CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2015-09-01",
        "status": "A",
        "authorized_official_last_name": "RALSTON",
        "authorized_official_first_name": "CURTIS",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "479-274-2000"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AR",
            "license": "MC-0254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136194002",
            "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.