Healthcare Provider Details

I. General information

NPI: 1760255442
Provider Name (Legal Business Name): COOK WHOLESALE CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 11/15/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 2ND AVE
JASPER AL
35501
US

IV. Provider business mailing address

162 HIGHWAY 13 S
MORTON MS
39117-3352
US

V. Phone/Fax

Practice location:
  • Phone: 601-732-6334
  • Fax: 601-732-7124
Mailing address:
  • Phone: 601-732-6334
  • Fax: 601-732-7124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SARAH ANDERSON
Title or Position: CFO
Credential:
Phone: 601-732-6334