Provider Demographics
NPI:1275723090
Name:COLLINS, ODEAN
Entity Type:Individual
Prefix:
First Name:ODEAN
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S MILAM ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-2051
Mailing Address - Country:US
Mailing Address - Phone:806-358-2241
Mailing Address - Fax:806-358-3269
Practice Address - Street 1:2001 S MILAM ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-2051
Practice Address - Country:US
Practice Address - Phone:806-358-2241
Practice Address - Fax:806-358-3269
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0987460001Medicare PIN