1457962110 NPI number — MT. EATON MEDICAL GROUP

Table of content: DR. BRIAN ROBERT COLE PHARMD (NPI 1841966736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457962110 NPI number — MT. EATON MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MT. EATON MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1457962110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT EATON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44659-0206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-359-5489
Provider Business Mailing Address Fax Number:
330-359-5822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15988 E CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT. EATON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-359-5489
Provider Business Practice Location Address Fax Number:
330-359-5822
Provider Enumeration Date:
08/14/2020

Additional Information

Authorized Official

Authorized Official Last Name:
BYLER
Authorized Official First Name:
NOLAN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
330-359-5489

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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