Healthcare Provider Details

I. General information

NPI: 1477693380
Provider Name (Legal Business Name): WILLIAM M COLLINS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E MAIN ST
WHITESBURG KY
41858-7351
US

IV. Provider business mailing address

109 E MAIN ST
WHITESBURG KY
41858-7351
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-4488
  • Fax: 606-633-8383
Mailing address:
  • Phone: 606-633-4488
  • Fax: 606-633-8383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number23375
License Number StateKY

VIII. Authorized Official

Name: WILLAIM M COLLINS
Title or Position: OWNER
Credential: MD
Phone: 606-633-4488