MR. CONNIE DALE COOK PAC NPI 1164426128

NPI Information

NPI: 1164426128
Provider Name: MR. CONNIE DALE COOK, PAC
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
600 E MCDONALD AVE
MAN, WV
ZIP 25635
Phone: (304) 583-6541
Get Directions

MR. Connie Dale Cook, PAC is a medical physician assistant in Man, WV. MR. Connie Dale Cook, PAC NPI is 1164426128. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

600 E MCDONALD AVE
MAN, WV
ZIP 25635-097
Phone: (304) 583-6541
Fax: (304) 583-6018

The NPI 1164426128 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/8/2005 and was last updated on 2/11/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	626	WEST VIRGINIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	S98265	MEDICARE UPIN	WEST VIRGINIA
2	C02025091	MEDICARE ID-TYPE UNSPECIFIED	WEST VIRGINIA
3	3810000560	MEDICAID	WEST VIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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