1285663633 NPI number — JOE CHRISTOPHER COOK I MD, M.P.H., A.T.C

Table of content: JOE CHRISTOPHER COOK I MD, M.P.H., A.T.C (NPI 1285663633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285663633 NPI number — JOE CHRISTOPHER COOK I MD, M.P.H., A.T.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
JOE
Provider Middle Name:
CHRISTOPHER
Provider Name Prefix Text:
Provider Name Suffix Text:
I
Provider Credential Text:
MD, M.P.H., A.T.C
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:
1285663633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 722354
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73070-8783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-343-5763
Provider Business Mailing Address Fax Number:
704-246-3996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 BYRAM BUSINESS CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BYRAM
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39272-9636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-376-9960
Provider Business Practice Location Address Fax Number:
601-376-4676
Provider Enumeration Date:
06/30/2006

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: 208VP0000X , with the licence number:  22851 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2255A2300X , with the licence number: AT0272 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: 22851 , 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: 08172301 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".