Provider Demographics
NPI:1518175215
Name:COOLEY NEUROSURGICAL CLINIC INC
Entity Type:Organization
Organization Name:COOLEY NEUROSURGICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-229-8928
Mailing Address - Street 1:PO BOX 1216
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-1216
Mailing Address - Country:US
Mailing Address - Phone:419-229-8928
Mailing Address - Fax:419-229-5291
Practice Address - Street 1:830 W HIGH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3971
Practice Address - Country:US
Practice Address - Phone:419-229-8928
Practice Address - Fax:419-229-5291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049465207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000167548OtherANTHEM
OH0859441Medicaid
OH=========-003OtherMEDICAL MUTUAL
OH=========OtherEIN
OH=========OtherEIN
OH000000167548OtherANTHEM