Provider Demographics
NPI:1164023677
Name:COLLIER MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:COLLIER MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-574-1770
Mailing Address - Street 1:1661 STATE ROUTE 522 UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-8120
Mailing Address - Country:US
Mailing Address - Phone:740-574-1770
Mailing Address - Fax:740-574-8781
Practice Address - Street 1:1661 STATE ROUTE 522 UNIT 2
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-8120
Practice Address - Country:US
Practice Address - Phone:740-574-1770
Practice Address - Fax:740-574-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1164023677OtherNPI