NPIMap

Organization Active NPI

Cooper Clinic, PA

  • Clinic/Center
  • Charleston, AR
National Provider Identifier
1922014521
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
1801 E Main St
Charleston, AR 72933-9254
Phone
(479) 274-2000
NPI assigned
Aug 1, 2006
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 12

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

National Provider Directory

National Provider Directory
Tax ID family
Cooper Clinic (13 organizations share this tax ID)

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

1801 E Main St
Charleston, AR 72933-9254

Mailing address

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

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
138674002MedicaidAR

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 1, 2015.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441065600000",
    "number": "1922014521",
    "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": "1801 E MAIN ST",
            "city": "CHARLESTON",
            "state": "AR",
            "postal_code": "729339254",
            "telephone_number": "479-274-2000"
        }
    ],
    "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_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": "138674002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, 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.