1851362180 NPI number — DR. KEVIN LAMONT COLLINS DO

Table of content: DR. KEVIN LAMONT COLLINS DO (NPI 1851362180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851362180 NPI number — DR. KEVIN LAMONT COLLINS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
KEVIN
Provider Middle Name:
LAMONT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1851362180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 FARM SPRINGS RD
Provider Second Line Business Mailing Address:
PROHEALTH PHYSICIANS
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06032-2573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-284-5200
Provider Business Mailing Address Fax Number:
860-284-5333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 WOODLAND STREET
Provider Second Line Business Practice Location Address:
SUITE 42
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-249-9336
Provider Business Practice Location Address Fax Number:
860-247-6897
Provider Enumeration Date:
01/26/2006

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: 207Q00000X , with the licence number:  041836 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0505X , with the licence number: 041836 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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