Healthcare Provider Details

I. General information

NPI: 1992763858
Provider Name (Legal Business Name): COOK HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 5TH ST SE
COOK MN
55723-9702
US

IV. Provider business mailing address

10 5TH ST SE
COOK MN
55723-9702
US

V. Phone/Fax

Practice location:
  • Phone: 218-666-5945
  • Fax: 218-666-6228
Mailing address:
  • Phone: 218-666-5945
  • Fax: 218-666-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number331536
License Number StateMN

VIII. Authorized Official

Name: MR. TERESA LYNN DEBEVEC
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 218-666-5945