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NPI Code Detail

MEDICARE: MR. DANIEL SCOT KOELE PA

MEDICARE: MR. DANIEL SCOT KOELE PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantA590SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528028602
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DANIEL SCOT KOELE PA
Provider Business Mailing Address
First Line : 420 W CAROLINA AVE
Second Line :
City : HARTSVILLE
State : SC
Zip : 29550-4524
Country : US
Telephone Number : 843-917-4977
Fax Number : 888-854-0390
Provider Business Practice Location Address
First Line : 2829 E HIGHWAY 76
Second Line :
City : MULLINS
State : SC
Zip : 29574-6035
Country : US
Telephone Number : 843-431-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 11/30/2020

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