Provider Demographics
NPI:1124017819
Name:GARY B COLE, MD, PA
Entity Type:Organization
Organization Name:GARY B COLE, MD, PA
Other - Org Name:FASTRAC MINOR EMERGENCY CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-577-7700
Mailing Address - Street 1:PO BOX 531
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75456-0531
Mailing Address - Country:US
Mailing Address - Phone:903-577-7700
Mailing Address - Fax:903-577-7706
Practice Address - Street 1:901 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-3259
Practice Address - Country:US
Practice Address - Phone:903-577-7700
Practice Address - Fax:903-577-7706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3237261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0020LWOtherBCBS
TX8P5370OtherBCBS
TX172541201Medicaid
TX172841201Medicaid
TX8C7048Medicare PIN
TX0020LWOtherBCBS
TX172841201Medicaid