=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770749756
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILL PAGE COLEMAN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2008
-----------------------------------------------------
Last Update Date | 07/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 MEDICAL CENTER PKWY SUITE 10
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77340-4942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-435-0833
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 643 INTERSTATE 45 S SUITE B
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77340-6434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-203-6977
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | L6014
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------