| Cooke's Continence Center | |
|
330-c Pelham Road Suite B-102 Greenville SC 29615-2961 | |
| (864) 412-8424 | |
| (864) 412-8012 |
| Full Name | Cooke's Continence Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 330-c Pelham Road, Greenville, South Carolina |
| Authorized Official Name and Position | Shannon Marie Cooke (WOMEN'S HEALTH NURSE PRACTITIONER) |
| Authorized Official Contact | 8644128424 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cooke's Continence Center 330-c Pelham Road Suite B-102 Greenville SC 29615-3534 Ph: (864) 412-8424 | Cooke's Continence Center 330-c Pelham Road Suite B-102 Greenville SC 29615-2961 Ph: (864) 412-8424 |
| NPI Number | 1023557485 |
|---|---|
| Provider Enumeration Date | 02/18/2017 |
| Last Update Date | 03/07/2023 |
| Medicare PECOS PAC ID | 8628354057 |
|---|---|
| Medicare Enrollment ID | O20170419000148 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023557485 | NPI | - | NPPES |
| 3302 | Other | SC | SC STATE LICENSE |
| 1619168473 | Other | SC | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 3302 (South Carolina) | Primary |
| Provider Name | Shannon M Cooke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619168473 PECOS PAC ID: 5991883506 Enrollment ID: I20080423000246 |
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