1003815325 NPI number — STANLEY D COOK MD

Table of content: STANLEY D COOK MD (NPI 1003815325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003815325 NPI number — STANLEY D COOK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
STANLEY
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1003815325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3780
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79116-3780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-355-3352
Provider Business Mailing Address Fax Number:
806-355-5367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 MEDI PARK DR
Provider Second Line Business Practice Location Address:
SUITE 2050
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-355-3352
Provider Business Practice Location Address Fax Number:
806-355-5367
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  G7503 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 129122103 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8F7707 . This is a "BLUE CROSS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: MDG7503 . This is a "TEXAS WORKERS COMPENSATIO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100130410A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129122106 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 751375446 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00338146 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 16533038 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137298101 . This is a "FIRSTCARE" identifier . This identifiers is of the category "OTHER".




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