MEDICARE: COLLINS FISHER RADIOLOGY ASSOCIATES

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	2085R0202X	Diagnostic Radiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CP3077	OTHER	TX	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1386629772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLINS FISHER RADIOLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 421209
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77242-1209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 HWY 59 BYPASS
Second Line	:
City	:	WHARTON
State	:	TX
Zip	:	77488
Country	:	US
Telephone Number	:	713-481-3533
Fax Number	:	713-432-0221

Authorized Official
Title or Position	:	OWNER
Name	:	DR. O. PRESTON COPELAND
Credential	:	M.D.
Telephone Number	:	713-481-3533

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	03/20/2009

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