Provider Demographics
NPI:1215236245
Name:COOK CHILDREN'S MEDICAL CENTER
Entity type:Organization
Organization Name:COOK CHILDREN'S MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO, CCHCS
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:682-885-4871
Mailing Address - Fax:682-885-3936
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-2500
Practice Address - Fax:682-885-1903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOK CHILDREN'S MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-16
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000332101Y00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164507273OtherASSOCIATED NPI NUMBER
1982830550OtherASSOCIATED NPI NUMBER
TX1215327374OtherASSOCIATED NPI
TX1447457312OtherASSOCIATED NPI
TX1538177209OtherASSOCIATED NPI
1962589507OtherASSOCIATED NPI NUMBER