Provider Demographics
NPI:1891765178
Name:COOK CHILDREN'S MEDICAL CENTER
Entity Type:Organization
Organization Name:COOK CHILDREN'S MEDICAL CENTER
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:682-885-4480
Mailing Address - Street 1:PO BOX 99213
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0213
Mailing Address - Country:US
Mailing Address - Phone:682-885-1860
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4000
Practice Address - Fax:682-885-1903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000332273Y00000X, 282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130088105Medicaid
TX021194901Medicaid
453300Medicare PIN
453300Medicare PIN
TX1124482OtherUNITED PIN
TX021194901Medicaid
TX130088105OtherCIDC NUMBER