Organization
COLES HEALTHCARE SERVICES INC
Active
Other names
TRADITIONAL MEDICINE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD COLES PA-C (PRESIDENT)
(954) 593-5524
Entity
Organization
Contact information
Practice address
3898 W COMMERCIAL BLVD, TAMARAC, FL 33309-3326
(754) 444-8826
Mailing address
7961 NW 4TH PL, PLANTATION, FL 33324-1950
(754) 444-8826
(954) 856-2921
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
AP1506
FL
261QP2300X
Primary Care Clinic/Center
Primary
PA9104805
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B2150Y
PTAN
—
Enumeration date
02/11/2016
Last updated
02/11/2016
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