Provider Demographics
NPI:1508578121
Name:COOK CHILDREN'S MEDICAL CENTER - PROSPER
Entity Type:Organization
Organization Name:COOK CHILDREN'S MEDICAL CENTER - PROSPER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RHOADES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:168-288-5448
Mailing Address - Street 1:PO BOX 730108
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-0108
Mailing Address - Country:US
Mailing Address - Phone:682-885-1860
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:4200 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-9805
Practice Address - Country:US
Practice Address - Phone:940-484-4311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOK CHILDREN'S MEDICAL CENTER - PROSPER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty