Provider Demographics
NPI:1316127475
Name:WINDY COLE DPM
Entity type:Organization
Organization Name:WINDY COLE DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-285-3116
Mailing Address - Street 1:1533 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4471
Mailing Address - Country:US
Mailing Address - Phone:330-285-3116
Mailing Address - Fax:
Practice Address - Street 1:1533 S WATER ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4471
Practice Address - Country:US
Practice Address - Phone:330-285-3116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003245C213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2220715Medicaid
OH000000301088OtherANTHEM BCBS
OH2220715Medicaid
OH000000301088OtherANTHEM BCBS
OH4776560001Medicare NSC
OHSP04671Medicare PIN
OH4043822Medicare PIN