Provider Demographics
NPI:1033627930
Name:BRIDGET COLLINS, MD, LLC
Entity Type:Organization
Organization Name:BRIDGET COLLINS, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-212-9867
Mailing Address - Street 1:5903 KIINANI PL
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-9707
Mailing Address - Country:US
Mailing Address - Phone:808-212-9867
Mailing Address - Fax:
Practice Address - Street 1:3175 ELUA ST STE C
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1203
Practice Address - Country:US
Practice Address - Phone:808-212-9867
Practice Address - Fax:434-333-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-14
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-12374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty