MEDICARE: ANDREW C 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
1	171100000X	Acupuncturist	AC01597	TX

General Provider Information

NPI Number	:	1679940274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW C COLLINS

Provider Business Mailing Address
First Line	:	3001 W. LOOP 250 N. STE C-105 #312
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705
Country	:	US
Telephone Number	:	505-314-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	5813 W WADLEY AVE
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-5055
Country	:	US
Telephone Number	:	505-314-3700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANDREW CLAY COLLINS
Credential	:	DOM
Telephone Number	:	505-314-3700

Provider Enumeration Date	:	08/31/2015
Last Update Date	:	08/31/2015

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