Healthcare Provider Details

I. General information

NPI: 1851453039
Provider Name (Legal Business Name): ROGER COLLINS I RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 HARRODSBURG RD STE 228
LEXINGTON KY
40504-3500
US

IV. Provider business mailing address

2265 HARRODSBURG RD STE 228
LEXINGTON KY
40504-3517
US

V. Phone/Fax

Practice location:
  • Phone: 859-229-5390
  • Fax: 859-373-8127
Mailing address:
  • Phone: 859-229-5390
  • Fax: 859-373-8127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number0744
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: