Provider Demographics
NPI:1386642080
Name:COLE CENTER FOR HEALING, INC
Entity Type:Organization
Organization Name:COLE CENTER FOR HEALING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:513-563-4321
Mailing Address - Street 1:7760 UNIVERSITY CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-3371
Mailing Address - Country:US
Mailing Address - Phone:513-563-4321
Mailing Address - Fax:513-847-1017
Practice Address - Street 1:7760 UNIVERSITY CT
Practice Address - Street 2:STE C
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3371
Practice Address - Country:US
Practice Address - Phone:513-563-4321
Practice Address - Fax:513-847-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004375C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000017595OtherANTHEM
OH080150714OtherRAILROAD MEDICARE
OH1S37037OtherUMWA HEALTH AND RETIREMEN
OH0437505OtherHUMANA/CHOICE CARE
OHOI04689OtherUNITED HEALTHCARE
A17598Medicare UPIN
OH000000017595OtherANTHEM