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General NPI Number Information
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NPI Number | 1235454828
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Entity Type | Organization
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Legal Business Name | COLLOM & CARNEY CLINIC ASSOCIATION
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 5002 COWHORN CREEK RD
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City | TEXARKANA
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State | TX
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Zip | 75503-9766
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Country | US
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Telephone | 903-614-3000
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Fax | 903-614-3525
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Provider Business Mailing Address
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Address Line | 2931 RICHMOND RD
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City | TEXARKANA
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State | TX
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Zip | 75503-2125
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Country | US
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Telephone | 903-614-3200
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Fax | 903-838-7551
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MARY E DWIGHT
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Credential | MHS, CCS-P, CMPE
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Telephone | 903-614-3282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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