1144223256 NPI number — ROBERT J COLE M.D.

Table of content: ROBERT J COLE M.D. (NPI 1144223256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144223256 NPI number — ROBERT J COLE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLE
Provider First Name:
ROBERT
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144223256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6077 PRIMACY PKWY STE 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38119-5754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-259-1600
Provider Business Mailing Address Fax Number:
901-259-1698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6286 BRIARCREST AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38120-4023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-259-1600
Provider Business Practice Location Address Fax Number:
901-259-2785
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  E-7432 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 21078 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: E-7432 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: 21078 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 620819926 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3058082 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 620819926 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5826093 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 620819926 . This is a "TRICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 620819926 . This is a "BCBS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 7187860 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8959498 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3371161 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3040325 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 000118678 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110318002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129321001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200025122 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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