Provider Demographics
NPI:1346296761
Name:NIX, COLLIER BUSSEY (MD)
Entity Type:Individual
Prefix:
First Name:COLLIER
Middle Name:BUSSEY
Last Name:NIX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STEWART
Other - Middle Name:COLLIER
Other - Last Name:BUSSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:1500 BROAD ST
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-8300
Practice Address - Country:US
Practice Address - Phone:570-368-2801
Practice Address - Fax:570-368-0609
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027597E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA138023F6KOtherMEDICARE
PA0011496380001Medicaid