1891957320 NPI number — DR. CHARLES R COLE M.D.

Table of content: DR. CHARLES R COLE M.D. (NPI 1891957320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891957320 NPI number — DR. CHARLES R COLE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLE
Provider First Name:
CHARLES
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
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:
1891957320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72745-0550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-463-7775
Provider Business Mailing Address Fax Number:
479-463-7864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3276 N NORTH HILLS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-587-1114
Provider Business Practice Location Address Fax Number:
479-587-1119
Provider Enumeration Date:
06/26/2008

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: E-11494 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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