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1740288117

NPI Code Detail

MEDICARE: JAMES LANE COLLIER CRNA

MEDICARE: JAMES LANE COLLIER CRNA

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	367500000X	Certified Registered Nurse Anesthetist	577239	TX

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
2	8307UB	OTHER	TX	BCBS
3	83899U	OTHER	TX	BLUE CROSS
4	82711	OTHER	AR	BLUE CROSS
5	TIN PLUS 015	OTHER	TX	TRICARE
6	75-1976930-005	OTHER	TX	TRICARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	8339UE	OTHER	TX	BCBS
11	P00933609	OTHER	TX	RAILROAD

General Provider Information

NPI Number	:	1740288117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES LANE COLLIER CRNA

Provider Business Mailing Address
First Line	:	PO BOX 841656
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-1656
Country	:	US
Telephone Number	:	903-531-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E DAWSON ST
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-2036
Country	:	US
Telephone Number	:	903-531-4500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	10/14/2014

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Directions to “ JAMES LANE COLLIER CRNA” Practice Location

Language	Start Address	Practice Location

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