Provider Demographics
NPI:1598227209
Name:COOK, SCOTT M
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:COOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 STATE HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:ROCKY COMFORT
Mailing Address - State:MO
Mailing Address - Zip Code:64861-8106
Mailing Address - Country:US
Mailing Address - Phone:417-669-9194
Mailing Address - Fax:
Practice Address - Street 1:256 STATE HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:ROCKY COMFORT
Practice Address - State:MO
Practice Address - Zip Code:64861-8106
Practice Address - Country:US
Practice Address - Phone:417-669-9194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO347C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Yes347C00000XTransportation ServicesPrivate Vehicle