1700813979 NPI number — SCOTT COLLINS P.A.-C.

Table of content: SCOTT COLLINS P.A.-C. (NPI 1700813979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700813979 NPI number — SCOTT COLLINS P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
SCOTT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700813979
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 NORTHBROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALMOUTH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04105-1318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-781-4424
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 NORTHBROOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALMOUTH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04105-1318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-781-4424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  PA-864 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010507276 . This is a "TAX ID" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1120990001 . This is a "DMERC" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 30333267 . This is a "NH MEDICAID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 7554653 . This is a "AETNA NON-HMO" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 3690583 . This is a "AETNA HMO" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 424650099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00239889 . This is a "RR MEDICARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 047836 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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