Provider Demographics
NPI:1770755183
Name:KENNETH N COATES
Entity type:Organization
Organization Name:KENNETH N COATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:N
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-632-7878
Mailing Address - Street 1:1512 N UNION BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2884
Mailing Address - Country:US
Mailing Address - Phone:719-632-7878
Mailing Address - Fax:
Practice Address - Street 1:1512 N UNION BLVD
Practice Address - Street 2:STE 100
Practice Address - City:COLORADO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2884
Practice Address - Country:US
Practice Address - Phone:719-632-7878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO393213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0926740001Medicare NSC