Provider Demographics
NPI:1265614135
Name:COOLE MEDICAL LLC
Entity type:Organization
Organization Name:COOLE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-655-8040
Mailing Address - Street 1:1520 S DOBSON RD STE 319
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4711
Mailing Address - Country:US
Mailing Address - Phone:480-655-8040
Mailing Address - Fax:480-655-1640
Practice Address - Street 1:1520 S DOBSON RD STE 319
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4711
Practice Address - Country:US
Practice Address - Phone:480-655-8040
Practice Address - Fax:480-655-1640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3771174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG74732Medicare UPIN