1295104396 NPI number — WOUND CARE CENTER AT GLASGOW

Table of content: MICHAEL WAYNE COLE O.D. (NPI 1689970667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295104396 NPI number — WOUND CARE CENTER AT GLASGOW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOUND CARE CENTER AT GLASGOW
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:
6
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:
1295104396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
507 S L ROGERS WELLS BLVD
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
GLASGOW
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42141-1043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-629-2273
Provider Business Mailing Address Fax Number:
270-629-2278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
507 S L ROGERS WELLS BLVD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
GLASGOW
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42141-1043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-629-2273
Provider Business Practice Location Address Fax Number:
270-629-2278
Provider Enumeration Date:
09/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FRANKLIN
Authorized Official First Name:
VIVIAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
APRN
Authorized Official Telephone Number:
270-629-2273

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: K184430 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100578180 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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