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NPI Code Detail

MEDICARE: COOK CHILDREN'S MEDICAL CENTER

MEDICARE: COOK CHILDREN'S MEDICAL CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician000332TX

General Provider Information

NPI Number : 1154789238
Entity Type Code : Organization
Provider Name (Legal Business Name) : COOK CHILDREN'S MEDICAL CENTER
Provider Business Mailing Address
First Line : PO BOX 99213
Second Line :
City : FORT WORTH
State : TX
Zip : 76199-0213
Country : US
Telephone Number : 682-885-1860
Fax Number : 682-885-1396
Provider Business Practice Location Address
First Line : 10601 N RIVERSIDE DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-2118
Country : US
Telephone Number : 817-347-2600
Fax Number : 817-347-2670
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : CORY R RHOADES
Credential :
Telephone Number : 682-885-4480
Provider Enumeration Date : 02/04/2016
Last Update Date : 04/08/2021

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Practice Fax: 817-347-2670

Directions to “COOK CHILDREN'S MEDICAL CENTER ” Practice Location

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