MEDICARE: WAYNE C COLE

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	01286	KY

General Provider Information

NPI Number	:	1871609842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE C COLE

Provider Business Mailing Address
First Line	:	PO BOX 310
Second Line	:	121 EAST MAIN ST
City	:	PROVIDENCE
State	:	KY
Zip	:	42450
Country	:	US
Telephone Number	:	270-667-2023
Fax Number	:	270-667-7518

Provider Business Practice Location Address
First Line	:	121 EAST MAIN ST
Second Line	:
City	:	PROVIDENCE
State	:	KY
Zip	:	42450
Country	:	US
Telephone Number	:	270-667-2023
Fax Number	:	270-667-7518

Authorized Official
Title or Position	:	OFFICE ASSISTANT
Name	:	MRS. SHANNON C LAYTON
Credential	:	DO
Telephone Number	:	270-667-2023

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/17/2009

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