MEDICARE: MARK J. COLLINS, D.O., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	2084P0800X	Psychiatry Physician	NV
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NV
3	2084P0804X	Child & Adolescent Psychiatry Physician	NV

General Provider Information

NPI Number	:	1134376288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK J. COLLINS, D.O., P.C.

Provider Business Mailing Address
First Line	:	6000 W ROCHELLE AVE
Second Line	:	SUITE 1500
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3376
Country	:	US
Telephone Number	:	702-221-2177
Fax Number	:	702-221-2187

Provider Business Practice Location Address
First Line	:	6000 W ROCHELLE AVE
Second Line	:	SUITE 1500
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3376
Country	:	US
Telephone Number	:	702-221-2177
Fax Number	:	702-221-2187

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. MARK J COLLINS
Credential	:	D.O.
Telephone Number	:	702-221-2177

Provider Enumeration Date	:	08/20/2008
Last Update Date	:	08/20/2008

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