Healthcare Provider Details

I. General information

NPI: 1386009538
Provider Name (Legal Business Name): MITCHELL COLES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 S KANAWHA ST STE 7
BECKLEY WV
25801-6763
US

IV. Provider business mailing address

1038 N EISENHOWER DR SUITE 235
BECKLEY WV
25801-3116
US

V. Phone/Fax

Practice location:
  • Phone: 304-237-5563
  • Fax: 304-250-4948
Mailing address:
  • Phone: 304-237-5563
  • Fax: 304-250-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: