Provider Demographics
NPI:1386009538
Name:COLES, MITCHELL
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:COLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 N EISENHOWER DR
Mailing Address - Street 2:SUITE 235
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3116
Mailing Address - Country:US
Mailing Address - Phone:304-237-5563
Mailing Address - Fax:304-250-4948
Practice Address - Street 1:2214 S KANAWHA ST
Practice Address - Street 2:STE 7
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6763
Practice Address - Country:US
Practice Address - Phone:304-237-5563
Practice Address - Fax:304-250-4948
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator