MEDICARE: BRANDON COREY COLE RDMS, RVT, RNCST

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist	CERTIFICATE 627AAET	TX
2	2471V0105X	Vascular Sonography Radiologic Technologist	95167 ARDMS	TX

General Provider Information

NPI Number	:	1912192204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON COREY COLE RDMS, RVT, RNCST

Provider Business Mailing Address
First Line	:	PO BOX 2072
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-0036
Country	:	US
Telephone Number	:	214-732-8165
Fax Number	:	866-261-1293

Provider Business Practice Location Address
First Line	:	7552 MAIN ST
Second Line	:	SUITE 202
City	:	THE COLONY
State	:	TX
Zip	:	75056-3448
Country	:	US
Telephone Number	:	214-732-8165
Fax Number	:	866-261-1293

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

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	05/11/2011

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