Provider Demographics
NPI:1134287162
Name:COLEMAN & COLEMAN PSC
Entity Type:Organization
Organization Name:COLEMAN & COLEMAN PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-432-5806
Mailing Address - Street 1:419 TOWN MT RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501
Mailing Address - Country:US
Mailing Address - Phone:606-432-5806
Mailing Address - Fax:606-432-8174
Practice Address - Street 1:419 TOWN MT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501
Practice Address - Country:US
Practice Address - Phone:606-432-5806
Practice Address - Fax:606-432-8174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65919060Medicaid
4066Medicare ID - Type Unspecified