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PED453300-36 COOK CHILDREN'S MEDICAL CENTER (Active)
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Main Details
Name
COOK CHILDREN'S MEDICAL CENTER
Subdivision Name
Teddy Bear Transport
Type
Children's Hospital
Rural
No
340B ID
PED453300-36
Medicare Provider Number
453300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/14/2015
Last Recertification Date
8/12/2024
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
124 Texas Way
Fort Worth, TX 76106
Billing Address
Cook Childrens Medical Center
801 7th Avenue
Fort Worth, TX 76104
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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