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
1	3416L0300X	Land Ambulance	220060	TX
2	3416A0800X	Air Ambulance	220060	TX

General Provider Information

NPI Number	:	1215907530
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	:	124 TEXAS WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76106-2773
Country	:	US
Telephone Number	:	682-885-3901
Fax Number	:	682-885-3902

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	CORY R RHOADES
Credential	:
Telephone Number	:	682-885-4480

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	04/08/2021

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