MEDICARE: KENNETH W COLLINS MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	00019312	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	051032734	OTHER	AL	BCBS
3	5945219	OTHER	AL	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	051078486	OTHER	AL	BCBS PROVIDER NUMBER
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487649497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH W COLLINS MD

Provider Business Mailing Address
First Line	:	PO BOX 11407
Second Line	:	DRAWER 0314
City	:	BIRMINGHAM
State	:	AL
Zip	:	35246-0314
Country	:	US
Telephone Number	:	405-751-4664
Fax Number	:	405-749-4561

Provider Business Practice Location Address
First Line	:	101 SIVLEY RD SW
Second Line	:	EM DEPT
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-4421
Country	:	US
Telephone Number	:	256-265-9905
Fax Number	:	256-265-9910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	02/10/2010

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Directions to “ KENNETH W COLLINS MD” Practice Location

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