1730186958 NPI number — DR. SHARON A COLLINS M. D.

Table of content: DR. SHARON A COLLINS M. D. (NPI 1730186958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730186958 NPI number — DR. SHARON A COLLINS M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
SHARON
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M. D.
Provider Gender Code:
F

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:
1730186958
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/20/2006
NPI Reactivation Date:
03/23/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 10TH ST SE
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52403-2442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-363-3600
Provider Business Mailing Address Fax Number:
319-363-9971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 10TH ST SE
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52403-2442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-363-3600
Provider Business Practice Location Address Fax Number:
319-363-9971
Provider Enumeration Date:
07/01/2005

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: 208000000X , with the licence number:  26978 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 182329 . This is a "WELLMARK BLUE CROSS BL S" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1053173 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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