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Nicole Renae Bane

Internal Medicine

Allopathic & Osteopathic Physicians

1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638

PECOS Enrollment

This provider is enrolled in PECOS as NICOLE BANE.

Based on the most recent information from CMS, provider Nicole Renae Bane is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1629480462
Provider Type
Individual
Full Name
Bane, Nicole Renae
Gender
Female

Sole Proprietor
No
Enumeration Date
5/28/2014
Last Updated
2/23/2021

Contact Information

Practice Location

1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638

(724) 494-0341

(210) 292-7868

Mailing Location

1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638

Unlisted Phone

(210) 292-7868

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License OS018569 Pennsylvania
Code 207R00000X	Description Internal Medicine Allopathic & Osteopathic Physicians	License OT015982 Pennsylvania

Nicole Renae Bane

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Campbell, Miles

Lundberg, Doris

Brumble, Jessica Lee

Delmar, Judith

Corrigan, Paula

Young, David G

Rokeh, Krista Rc

Rodriguez, Rechell

Murphy, Taylor Aaron

Rodrigues, Matthew Bryant