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PED453300-01 COOK CHILDREN'S MEDICAL CENTER (Terminated)
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Main Details
Name
COOK CHILDREN'S MEDICAL CENTER
Subdivision Name
Grapevine ~ Hematology & Oncology
Type
Children's Hospital
Rural
No
340B ID
PED453300-01
Medicare Provider Number
453300
Outpatient Facility Provider Number
453300
Additional Details
Current Program Status
Terminated
Registration Date
7/22/2011
Participating Start Date
10/1/2011
Participating Approval Date
9/15/2011
Last Recertification Date
8/12/2024
Termination Date
Termination Reason
10/1/2024
Site closure
Contacts
Authorizing Official
Cook Children's Medical Center
Nancy Cychol, EVP, Hospital Services
(682) 885-4340
Primary Contact
Cook Children's Medical Center
Ashlee Hubbard, Strategic Business Manager, Finance
(682) 303-0423
Addresses
Street Address
1600 W Northwest Highway, Ste 500
Grapevine, TX 76051-0000
Billing Address
Cook Children's Medical Center
801 7th Avenue
Fort Worth, TX 76104
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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