1285794347 NPI number — LINDELL Y COLLINS MD

Table of content: LINDELL Y COLLINS MD (NPI 1285794347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285794347 NPI number — LINDELL Y COLLINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
LINDELL
Provider Middle Name:
Y
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1285794347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W THOMAS RD
Provider Second Line Business Mailing Address:
STE 620
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-776-9511
Provider Business Mailing Address Fax Number:
602-776-9517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W THOMAS RD
Provider Second Line Business Practice Location Address:
STE 620
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-776-9511
Provider Business Practice Location Address Fax Number:
602-776-9517
Provider Enumeration Date:
12/11/2006

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: 208000000X , with the licence number:  14074 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 234807 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ0865430 . This is a "BCBS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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