Provider Demographics
NPI:1124157631
Name:COFFEYVILLE ORTHOPAEDICS, PA
Entity type:Organization
Organization Name:COFFEYVILLE ORTHOPAEDICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXIME
Authorized Official - Middle Name:JEAN-MARIE
Authorized Official - Last Name:COLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-251-3838
Mailing Address - Street 1:1501 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-3307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1501 W 4TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3307
Practice Address - Country:US
Practice Address - Phone:620-251-3838
Practice Address - Fax:620-251-0736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS31291207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS104827Medicare ID - Type Unspecified
KSE73248Medicare UPIN