Provider Demographics
NPI:1336233626
Name:COLE, BILLY J II (DO)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:J
Last Name:COLE
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2812
Mailing Address - Country:US
Mailing Address - Phone:304-250-0333
Mailing Address - Fax:304-250-0334
Practice Address - Street 1:302 CARRIAGE DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2812
Practice Address - Country:US
Practice Address - Phone:304-250-0333
Practice Address - Fax:304-250-0334
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1924207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
274680OtherUNITEDHEALTHCARE
WVA01924Medicaid
207087OtherCARELINK
WV1812149000Medicaid
WV55850Medicaid
274680OtherUNITEDHEALTHCARE
WVCO2026364Medicare ID - Type Unspecified
WVA01924Medicaid
WVCO2026361Medicare ID - Type Unspecified
WV55850Medicaid