Provider Demographics
NPI:1699810796
Name:COLE CLINIC, PA
Entity Type:Organization
Organization Name:COLE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-298-3640
Mailing Address - Street 1:4716 ALLIANCE BLVD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5371
Mailing Address - Country:US
Mailing Address - Phone:469-298-3640
Mailing Address - Fax:469-298-3646
Practice Address - Street 1:4716 ALLIANCE BLVD
Practice Address - Street 2:SUITE 218
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5371
Practice Address - Country:US
Practice Address - Phone:469-298-3640
Practice Address - Fax:469-298-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178660002Medicaid
TX178660001Medicaid
TXI13870Medicare UPIN
TX00871YMedicare PIN
TX178660002Medicaid