MEDICARE: COLLOM & CARNEY CLINIC ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134101108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLOM & CARNEY CLINIC ASSOCIATION

Provider Business Mailing Address
First Line	:	4800 TEXAS BLVD
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-3033
Country	:	US
Telephone Number	:	903-614-3600
Fax Number	:	903-792-0951

Provider Business Practice Location Address
First Line	:	225 N. DUDNEY RD
Second Line	:
City	:	MAGNOLIA
State	:	AR
Zip	:	71753-3110
Country	:	US
Telephone Number	:	903-614-3600
Fax Number	:	903-792-0951

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. PAT ROBERTS
Credential	:
Telephone Number	:	903-614-3601

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	03/23/2010

Similar Medicare Providers

1316185754 — MRS. JUDITH W GAYLORD
Practice Location Address:

219 N DUDNEY RD
MAGNOLIA, AR
71753-3110

Practice Phone: 870-234-2425
Practice Fax:

1619998937 — WALGREEN CO
Practice Location Address:

52 W BIRDIE LN
MAGNOLIA, DE
19962-3110

Practice Phone: 302-697-7435
Practice Fax: 302-697-8593

1881978161 — KAREN YUEN PHARM.D.
Practice Location Address:

52 W BIRDIE LN
MAGNOLIA, DE
19962-3110

Practice Phone: 302-697-7435
Practice Fax:

1326323247 — CANDICE JACQUELINE O'GARRO RPH
Practice Location Address:

52 W BIRDIE LN
MAGNOLIA, DE
19962-3110

Practice Phone: 302-697-7435
Practice Fax: 302-697-8593

1295596773 — LEAH POTTS
Practice Location Address:

3110 MAGNOLIA AVE APT A
SAINT LOUIS, MO
63118-1272

Practice Phone: 314-345-0597
Practice Fax:

1679914154 — MELISSA B HANISH FNP
Practice Location Address:

1617 N WASHINGTON
MAGNOLIA, AR
71753-2046

Practice Phone: 870-234-7676
Practice Fax: 570-562-2559

Directions to “COLLOM & CARNEY CLINIC ASSOCIATION ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.