Organization
ABILENE BONE & JOINT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON EUGENE COOKE M.D. (PRESIDENT)
(325) 672-4372
Entity
Organization
Contact information
Practice address
1749 PINE ST, ABILENE, TX 79601-3043
(325) 672-4372
(325) 673-0856
Mailing address
1749 PINE ST, ABILENE, TX 79601-3043
(325) 672-4372
(325) 673-0856
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
6357380001
TX
335E00000X
Prosthetic/Orthotic Supplier
6357380001
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0075MS
BCBS GROUP #
TX
05
—
170619401
—
TX
Enumeration date
06/23/2006
Last updated
06/01/2010
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