Provider Demographics
NPI:1558752741
Name:COLE AESTHETIC CENTER
Entity Type:Organization
Organization Name:COLE AESTHETIC CENTER
Other - Org Name:ERIC A COLE MD PS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:360-613-2600
Mailing Address - Street 1:9800 LEVIN RD NW STE 101
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7849
Mailing Address - Country:US
Mailing Address - Phone:360-613-2600
Mailing Address - Fax:360-692-3535
Practice Address - Street 1:9800 LEVIN RD NW STE 101
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7849
Practice Address - Country:US
Practice Address - Phone:360-613-2600
Practice Address - Fax:360-692-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000372402086S0122X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG74220Medicare UPIN