NPIMap

Organization Active NPI

Cook Children's Medical Center

Doing business as Cook Children's Urgent Care Southlake

  • Pediatrics Physician
  • Southlake, TX
National Provider Identifier
1114222312
Registry record updated May 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
000332 Issued in TX
Legal business name
COOK CHILDREN'S MEDICAL CENTER
Doing business as
Cook Children's Urgent Care Southlake
Practice address
2727 E Southlake Blvd
Southlake, TX 76092-6613
Phone
(682) 885-6000
Fax
(682) 885-6050
NPI assigned
Jan 19, 2011
Last updated
May 26, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
COOK CHILDREN'S MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 26, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cory R Rhoades
Title
Chief Financial Officer
Phone
(682) 885-4480

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 000332 TX Primary

Addresses

Primary practice location

2727 E Southlake Blvd
Southlake, TX 76092-6613

Mailing address

PO Box 99213
Fort Worth, TX 76199-0213
Phone (682) 885-1860

Other names 1

  • COOK CHILDREN'S URGENT CARE SOUTHLAKE Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2018154Cook Children's Southlake Urgent2727 East Southlake Blvd, Southlake, TX 76092Certificate of waiverApr 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
Cook Fort Worth Childre25 organizations share this tax ID, including this one
Part of
Cook Fort Worth Childre

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Locations

801 Matlock Rd
Mansfield, TX 76063
Phone (817) 347-8400

2727 E Southlake Blvd
Southlake, TX 76092
Phone (682) 885-6000

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621987200000",
    "number": "1114222312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99213",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761990213",
            "telephone_number": "682-885-1860",
            "fax_number": "682-885-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2727 E SOUTHLAKE BLVD",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926613",
            "telephone_number": "682-885-6000",
            "fax_number": "682-885-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOK CHILDREN'S MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COOK CHILDREN'S MEDICAL CENTER",
        "enumeration_date": "2011-01-19",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A",
        "authorized_official_last_name": "RHOADES",
        "authorized_official_first_name": "CORY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "682-885-4480"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "000332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COOK CHILDREN'S URGENT CARE SOUTHLAKE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.