Healthcare Provider Details

I. General information

NPI: 1427389543
Provider Name (Legal Business Name): COOPER SURGERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 PARKSIDE DRIVE SUITE 204
KNOXVILLE TN
37934
US

IV. Provider business mailing address

10810 PARKSIDE DRIVE SUITE 204
KNOXVILLE TN
37934
US

V. Phone/Fax

Practice location:
  • Phone: 865-675-2080
  • Fax: 877-896-7807
Mailing address:
  • Phone: 865-675-2080
  • Fax: 877-896-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number41864
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number41864
License Number StateTN

VIII. Authorized Official

Name: DR. MARK HAYDEN COOPER
Title or Position: OWNER THORACIC SURGEON
Credential: M.D.
Phone: 865-257-5896