1144542358 NPI number — MR. TODD A COLE JD, CM, FACILITATOR

Table of content: MR. TODD A COLE JD, CM, FACILITATOR (NPI 1144542358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144542358 NPI number — MR. TODD A COLE JD, CM, FACILITATOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLE
Provider First Name:
TODD
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
JD, CM, FACILITATOR
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:
1144542358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4528 S SHERIDAN RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74145-1140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-398-7979
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4528 S SHERIDAN RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74145-1140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-398-7979
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2010

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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