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General NPI Number Information
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NPI Number | 1700127909
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Entity Type | Organization
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Legal Business Name | COOK CHILDREN'S MEDICAL CENTER
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 801 7TH AVE STE 1700
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City | FORT WORTH
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State | TX
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Zip | 76104-2796
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Country | US
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Telephone | 682-885-3142
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Fax | 682-885-6916
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Provider Business Mailing Address
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Address Line | PO BOX 99213
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City | FORT WORTH
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State | TX
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Zip | 76199-0213
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Country | US
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Telephone | 682-885-4183
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Fax | 682-885-7990
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | CORY R RHOADES
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Credential |
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Telephone | 682-885-4480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28690
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License Number State | TX
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