Provider Demographics
NPI:1164576294
Name:JANICE -BROWN COLLINS FAMILY PLANNING CLINIC
Entity Type:Organization
Organization Name:JANICE -BROWN COLLINS FAMILY PLANNING CLINIC
Other - Org Name:COLLINS FAMILY PLANNING CLINIC, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:APN, WHNP-BC
Authorized Official - Phone:817-922-8182
Mailing Address - Street 1:2900 SE LOOP 820
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76140-1013
Mailing Address - Country:US
Mailing Address - Phone:817-922-8182
Mailing Address - Fax:
Practice Address - Street 1:2900 SE LOOP 820
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76140-1013
Practice Address - Country:US
Practice Address - Phone:817-922-8182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX544870261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164611902Medicaid