Provider Demographics
NPI:1083124192
Name:COCKS MEDICAL.LLC
Entity Type:Organization
Organization Name:COCKS MEDICAL.LLC
Other - Org Name:PINNACLE NATURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CESILIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COCKS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:360-798-8727
Mailing Address - Street 1:4713 NE 139TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-6346
Mailing Address - Country:US
Mailing Address - Phone:360-798-8727
Mailing Address - Fax:
Practice Address - Street 1:2115 SE 192ND AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7444
Practice Address - Country:US
Practice Address - Phone:360-798-8727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COCKS MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty