1053388975 NPI number — EDWIN N COOK D.O.

Table of content: EDWIN N COOK D.O. (NPI 1053388975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053388975 NPI number — EDWIN N COOK D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
EDWIN
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1053388975
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 SIOUX VALLEY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEROKEE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51012-1205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-225-5101
Provider Business Mailing Address Fax Number:
712-225-6880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 SIOUX VALLEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEROKEE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51012-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-225-5101
Provider Business Practice Location Address Fax Number:
712-225-6880
Provider Enumeration Date:
03/01/2006

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:  3236 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30278 . This is a "BLUE CROSS # CHEROKEE SIT" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 300135030 . This is a "RAILROAD MEDICARE #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 3518563 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4518563 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30285 . This is a "BLUE CROSS # IDA GROVE SI" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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