1942252606 NPI number — JAMES M COLLIER III M.D.

Table of content: JAMES M COLLIER III M.D. (NPI 1942252606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942252606 NPI number — JAMES M COLLIER III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLIER
Provider First Name:
JAMES
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
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:
1942252606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
169 BURT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40503-2455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-278-9242
Provider Business Mailing Address Fax Number:
859-278-0322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 E MAXWELL ST
Provider Second Line Business Practice Location Address:
STE. 303
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40508-2640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-425-1117
Provider Business Practice Location Address Fax Number:
859-425-1130
Provider Enumeration Date:
05/17/2006

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:  20763 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 64207632 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00151867 . This is a "RR MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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