MEDICARE: COL MANAGEMENT, LLC

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
1	2085R0202X	Diagnostic Radiology Physician		MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00147271	OTHER	MS	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1295808202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COL MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	4906 AMBASSADOR CAFFERY PARKWAY
Second Line	:	BUILDING F
City	:	LAFAYETTE
State	:	LA
Zip	:	70508
Country	:	US
Telephone Number	:	337-291-9161
Fax Number	:	337-289-0593

Provider Business Practice Location Address
First Line	:	2526 5TH ST N
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2019
Country	:	US
Telephone Number	:	662-328-8402
Fax Number	:	662-328-1554

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	JAMES W. HOLMES
Credential	:
Telephone Number	:	337-291-9161

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/21/2022

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Directions to “COL MANAGEMENT, LLC ” Practice Location

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