Healthcare Provider Details

I. General information

NPI: 1942241286
Provider Name (Legal Business Name): COLLOM &CARNEY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S CONSTITUTION AVE
ASHDOWN AR
71822
US

IV. Provider business mailing address

5002 COWHORN CREEK RD
TEXARKANA TX
75503
US

V. Phone/Fax

Practice location:
  • Phone: 870-898-2797
  • Fax:
Mailing address:
  • Phone: 903-614-3000
  • Fax: 903-614-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: REX THOMAS SIMMONS II
Title or Position: CEO ADMINISTRATOR
Credential:
Phone: 903-614-3280