Provider Demographics
NPI:1194813816
Name:COOPERS ANESTHESIA SERVICES
Entity type:Organization
Organization Name:COOPERS ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA/DIRECTOR ANESTHESIA SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:CRNA
Authorized Official - Phone:870-238-8848
Mailing Address - Street 1:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-0563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 FALLS BLVD S
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3013
Practice Address - Country:US
Practice Address - Phone:870-238-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR211947282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access