Provider Demographics
NPI:1447428834
Name:ELIZABETH COOK MD PC
Entity Type:Organization
Organization Name:ELIZABETH COOK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:F
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-272-3639
Mailing Address - Street 1:1624 S I ST
Mailing Address - Street 2:STE 202
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5016
Mailing Address - Country:US
Mailing Address - Phone:253-272-3639
Mailing Address - Fax:253-272-2014
Practice Address - Street 1:1624 S I ST
Practice Address - Street 2:STE 202
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5016
Practice Address - Country:US
Practice Address - Phone:253-272-3639
Practice Address - Fax:253-272-2014
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELIZABETH COOK MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034762261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1106582Medicaid
WAF87127Medicare UPIN