MEDICARE: RICHARD CLINTON COLE MD

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	207Q00000X	Family Medicine Physician	MD021619	TN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3145745	OTHER	TN	BLUE CROSS BLUE SHIELD TN

General Provider Information

NPI Number	:	1578558441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD CLINTON COLE MD

Provider Business Mailing Address
First Line	:	2106 N JACKSON ST
Second Line	:
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-2208
Country	:	US
Telephone Number	:	931-455-2045
Fax Number	:	931-455-9960

Provider Business Practice Location Address
First Line	:	2106 N JACKSON ST
Second Line	:
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-2208
Country	:	US
Telephone Number	:	931-455-2045
Fax Number	:	931-455-9960

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	05/27/2008

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