1871710715 NPI number — COOK WHOLESALE CO INC

Table of content: (NPI 1871710715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871710715 NPI number — COOK WHOLESALE CO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COOK WHOLESALE CO INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COOK MEDICAL SUPPLY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871710715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 LAKESHORE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PELAHATCHIE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39145-2711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-732-6334
Provider Business Mailing Address Fax Number:
601-732-7124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
162 HIGHWAY 13 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORTON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39117-3352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-732-6334
Provider Business Practice Location Address Fax Number:
601-732-7124
Provider Enumeration Date:
04/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
601-732-6334

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  04573 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00440675 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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