Provider Demographics
NPI:1477273233
Name:COLE CREATIVE & MEDICAL ARTS, PLLC
Entity Type:Organization
Organization Name:COLE CREATIVE & MEDICAL ARTS, PLLC
Other - Org Name:COLE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:945-426-8057
Mailing Address - Street 1:6304 HEINEMAN COURT
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-0188
Mailing Address - Country:US
Mailing Address - Phone:214-288-8981
Mailing Address - Fax:833-471-4886
Practice Address - Street 1:6304 HEINEMAN COURT
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-0188
Practice Address - Country:US
Practice Address - Phone:214-288-8981
Practice Address - Fax:833-471-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX460274001Medicaid