Basic Information
| Provider Information | |||||||||
| NPI: | 1568442309 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE COOPER HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 EXECUTIVE CAMPUS, ROUTE 70 | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080024103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563826522 | ||||||||
| FaxNumber: | 8563826547 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 COOPER PLZ | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563422000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 06/02/2011 | ||||||||
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| AuthorizedOfficialLastName: | SHIRLEY | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8563564708 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | FACILITY NO. 10402 | NJ | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 4136004 | 05 | NJ | MEDICAID |