Healthcare Provider Details

I. General information

NPI: 1699701870
Provider Name (Legal Business Name): ABILENE BONE & JOINT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1749 PINE ST
ABILENE TX
79601-3043
US

IV. Provider business mailing address

1749 PINE ST
ABILENE TX
79601-3043
US

V. Phone/Fax

Practice location:
  • Phone: 325-672-4372
  • Fax: 325-673-0856
Mailing address:
  • Phone: 325-672-4372
  • Fax: 325-673-0856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6357380001
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number6357380001
License Number StateTX

VIII. Authorized Official

Name: SHANNON EUGENE COOKE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 325-672-4372