MEDICARE: J.R. COLLIP, M.D., LLC.

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	208D00000X	General Practice Physician	01044478A	IN

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

General Provider Information

NPI Number	:	1538440516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.R. COLLIP, M.D., LLC.

Provider Business Mailing Address
First Line	:	PO BOX 438
Second Line	:	219 EAST MAIN STREET
City	:	MORRISTOWN
State	:	IN
Zip	:	46161-0438
Country	:	US
Telephone Number	:	765-763-0212
Fax Number	:	765-763-0210

Provider Business Practice Location Address
First Line	:	219 EAST MAIN STREET
Second Line	:
City	:	MORRISTOWN
State	:	IN
Zip	:	46161-0438
Country	:	US
Telephone Number	:	765-763-0212
Fax Number	:	765-763-0210

Authorized Official
Title or Position	:	M.D.
Name	:	JOHN RALPH COLLIP
Credential	:	M.D.
Telephone Number	:	765-763-0212

Provider Enumeration Date	:	09/02/2011
Last Update Date	:	09/02/2011

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