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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician
2	208800000X	Urology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CU0435	OTHER		RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1700868528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLOM & CARNEY CLINIC ASSOCIATION

Provider Business Mailing Address
First Line	:	5002 COWHORN CREEK RD
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-9766
Country	:	US
Telephone Number	:	903-614-3000
Fax Number	:	903-614-3525

Provider Business Practice Location Address
First Line	:	1902 MOORES LN
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-4610
Country	:	US
Telephone Number	:	903-792-7515
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR CONTRACTING CREDENTIALING
Name	:	DANA ROBYN MORTON
Credential	:
Telephone Number	:	903-614-3283

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	12/19/2025

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Directions to “COLLOM & CARNEY CLINIC ASSOCIATION ” Practice Location

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