MEDICARE: SNF PHYSIATRY SERVICES NC PLLC

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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1962230177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SNF PHYSIATRY SERVICES NC PLLC

Provider Business Mailing Address
First Line	:	8801 FAST PARK DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-4852
Country	:	US
Telephone Number	:	732-813-0799
Fax Number	:

Provider Business Practice Location Address
First Line	:	8801 FAST PARK DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-4852
Country	:	US
Telephone Number	:	732-813-0799
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES JEFFREY COLE
Credential	:	MD
Telephone Number	:	732-813-0799

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	09/02/2024

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