Healthcare Provider Details

I. General information

NPI: 1659841864
Provider Name (Legal Business Name): COLLINS WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 10TH ST STE 102
MARION IA
52302-3446
US

IV. Provider business mailing address

642 10TH ST STE 102
MARION IA
52302-3446
US

V. Phone/Fax

Practice location:
  • Phone: 844-544-8944
  • Fax: 844-544-8944
Mailing address:
  • Phone: 844-544-8944
  • Fax: 844-544-8944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1730186958
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: SHARON A COLLINS
Title or Position: OWNER
Credential: MD
Phone: 844-544-8944