Provider Demographics
NPI:1871609842
Name:WAYNE C COLE
Entity type:Organization
Organization Name:WAYNE C COLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:270-667-2023
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:121 EAST MAIN ST
Mailing Address - City:PROVIDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:42450
Mailing Address - Country:US
Mailing Address - Phone:270-667-2023
Mailing Address - Fax:270-667-7518
Practice Address - Street 1:121 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:KY
Practice Address - Zip Code:42450
Practice Address - Country:US
Practice Address - Phone:270-667-2023
Practice Address - Fax:270-667-7518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY01286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty