Provider Demographics
NPI:1548218043
Name:COOK'S FABRICATION, INC
Entity Type:Organization
Organization Name:COOK'S FABRICATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANAE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:317-782-1722
Mailing Address - Street 1:6011 E HANNA AVE
Mailing Address - Street 2:STE H
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-6118
Mailing Address - Country:US
Mailing Address - Phone:317-782-1722
Mailing Address - Fax:317-782-1721
Practice Address - Street 1:6011 E HANNA AVE
Practice Address - Street 2:STE H
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-6118
Practice Address - Country:US
Practice Address - Phone:317-782-1722
Practice Address - Fax:317-782-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5642670001Medicare ID - Type Unspecified