1255799334 NPI number — COOK CHILDREN'S MEDICAL CENTER

Table of content: (NPI 1255799334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255799334 NPI number — COOK CHILDREN'S MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COOK CHILDREN'S MEDICAL CENTER
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:
Provider Other Organization Name Type Code:
6
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:
1255799334
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 99213
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76199-0213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-885-1860
Provider Business Mailing Address Fax Number:
682-885-1396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10601 N RIVERSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76244-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-347-2600
Provider Business Practice Location Address Fax Number:
817-347-2670
Provider Enumeration Date:
02/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
RHOADES
Authorized Official First Name:
CORY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
682-885-4480

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  000332 , 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)





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