1124216015 NPI number — CHARLES D. COLLINS, MD, FACS

Table of content: MISS KATHY CHRISTINE WITT CSA (NPI 1053756981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124216015 NPI number — CHARLES D. COLLINS, MD, FACS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES D. COLLINS, MD, FACS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1124216015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 S TELSHOR BLVD
Provider Second Line Business Mailing Address:
SUITE 16-108
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88011-5071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-532-0880
Provider Business Mailing Address Fax Number:
575-532-6466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 S TELSHOR BLVD
Provider Second Line Business Practice Location Address:
SUITE 16-108
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88011-5071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-532-0880
Provider Business Practice Location Address Fax Number:
575-532-6466
Provider Enumeration Date:
10/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
575-532-0880

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  20030073 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 95582789 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com