Healthcare Provider Details

I. General information

NPI: 1588700017
Provider Name (Legal Business Name): JASON J. COLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N WALNUT ST
CHILLICOTHEE OH
45601-2420
US

IV. Provider business mailing address

272 HOSPITAL RD SUITE 3
CHILLICOTHEE OH
45601-9031
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4500
  • Fax: 740-779-8495
Mailing address:
  • Phone: 740-779-8234
  • Fax: 740-779-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number89168
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.089168
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: