MEDICARE: RICHARD LEE COBBLE JR.

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	343900000X	Non-emergency Medical Transport (VAN)	0480889	TN

General Provider Information

NPI Number	:	1861948465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD LEE COBBLE JR.

Provider Business Mailing Address
First Line	:	1135 MCDONALD RD
Second Line	:
City	:	MIDWAY
State	:	TN
Zip	:	37809
Country	:	US
Telephone Number	:	423-220-9338
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 MCDONALD RD
Second Line	:
City	:	MIDWAY
State	:	TN
Zip	:	37809-3615
Country	:	US
Telephone Number	:	423-220-9338
Fax Number	:

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	09/01/2016

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