Basic Information
| Provider Information | |||||||||
| NPI: | 1013972561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLE | ||||||||
| FirstName: | SYLVIA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 950202 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 BARRET AVE | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402041743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025407200 | ||||||||
| FaxNumber: | 5025407207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 10/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34656 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110186559 | 01 | KY | RAILROAD MEDICARE | OTHER | 64007545 | 05 | KY | MEDICAID | 00000074657 | 01 | KY | ANTHEM / NCMA | OTHER | 1103710 | 01 | KY | PASSPORT / NCMA | OTHER | 000026447B | 01 | KY | HUMANA / NCMA | OTHER | 200270750 | 05 | IN | MEDICAID | 2436382000 | 01 | KY | PASSPORT ADVANTAGE / NCMA | OTHER | 008912 | 01 | KY | SIHO / NCMA | OTHER |