Provider Demographics
NPI:1386625333
Name:UNIFOUR REHAB MEDICINE, PLLC
Entity type:Organization
Organization Name:UNIFOUR REHAB MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:COATES-WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-328-9200
Mailing Address - Street 1:2425 N CENTER ST
Mailing Address - Street 2:#302
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-1320
Mailing Address - Country:US
Mailing Address - Phone:828-328-9200
Mailing Address - Fax:828-328-9219
Practice Address - Street 1:1333 2ND ST NE STE 300
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2594
Practice Address - Country:US
Practice Address - Phone:828-328-9200
Practice Address - Fax:828-328-9219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903120Medicaid
NC5903120Medicaid