Provider Demographics
NPI:1215104773
Name:COOPER FUNCTIONAL SERVICES
Entity type:Organization
Organization Name:COOPER FUNCTIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-267-6222
Mailing Address - Street 1:2520 HARWOOD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6709
Mailing Address - Country:US
Mailing Address - Phone:817-267-6222
Mailing Address - Fax:817-545-3488
Practice Address - Street 1:2520 HARWOOD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6709
Practice Address - Country:US
Practice Address - Phone:817-267-6222
Practice Address - Fax:817-545-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5246261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center