Provider Demographics
NPI:1487272365
Name:COOK FOOT AND ANKLE SPECIALISTS LLC
Entity type:Organization
Organization Name:COOK FOOT AND ANKLE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:BRYCE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-752-9011
Mailing Address - Street 1:550 E 1400 N STE B
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2450
Mailing Address - Country:US
Mailing Address - Phone:435-752-9011
Mailing Address - Fax:435-752-7159
Practice Address - Street 1:935 N 1000 W
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-9356
Practice Address - Country:US
Practice Address - Phone:435-752-9011
Practice Address - Fax:435-752-7159
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOK FOOT AND ANKLE SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric