Provider Demographics
NPI:1083121495
Name:COOK CHILDREN'S SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:COOK CHILDREN'S SURGERY CENTER, LLC
Other - Org Name:COOK CHILDRENS SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EVP, HOSPITAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CYCHOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-885-4340
Mailing Address - Street 1:PO BOX 734041
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-4041
Mailing Address - Country:US
Mailing Address - Phone:817-605-2833
Mailing Address - Fax:817-605-2983
Practice Address - Street 1:6316 PRECINCT LINE RD STE B
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2766
Practice Address - Country:US
Practice Address - Phone:817-605-2950
Practice Address - Fax:817-605-2595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical