MEDICARE: VANESSA COBLE

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	332B00000X	Durable Medical Equipment & Medical Supplies	01040	NC
2	332BC3200X	Customized Equipment (DME)	01040	NC

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	:	1518376144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANESSA COBLE

Provider Business Mailing Address
First Line	:	540 W ELM ST
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-2158
Country	:	US
Telephone Number	:	336-227-0730
Fax Number	:	336-227-0732

Provider Business Practice Location Address
First Line	:	540 W ELM ST
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-2158
Country	:	US
Telephone Number	:	336-227-0730
Fax Number	:	336-227-0732

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VANESSA COBLE
Credential	:	PH.D.
Telephone Number	:	336-227-0730

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	08/07/2014

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Directions to “VANESSA COBLE ” Practice Location

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