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NPI Code Detail

MEDICARE: SAM COLLINS

MEDICARE: SAM COLLINS
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1154284826
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAM COLLINS
Provider Business Mailing Address
First Line : 12345 LAKE CITY WAY NE # 2208
Second Line :
City : SEATTLE
State : WA
Zip : 98125-5401
Country : US
Telephone Number : 206-965-0106
Fax Number :
Provider Business Practice Location Address
First Line : 12345 LAKE CITY WAY NE # 2208
Second Line :
City : SEATTLE
State : WA
Zip : 98125-5401
Country : US
Telephone Number : 206-965-0106
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2025
Last Update Date : 12/08/2025

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Directions to “ SAM COLLINS ” Practice Location

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