Provider Demographics
NPI:1407893316
Name:PREFERRED HOSPITAL LEASING INC
Entity Type:Organization
Organization Name:PREFERRED HOSPITAL LEASING INC
Other - Org Name:COLLINGSWORTH FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-878-0202
Mailing Address - Street 1:1011 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:79095-3704
Mailing Address - Country:US
Mailing Address - Phone:806-447-5311
Mailing Address - Fax:806-447-3090
Practice Address - Street 1:1011 15TH ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:TX
Practice Address - Zip Code:79095-3704
Practice Address - Country:US
Practice Address - Phone:806-447-5311
Practice Address - Fax:806-447-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126840106Medicaid
TX179285501Medicaid
TX126840108Medicaid
TX00629ZMedicare ID - Type UnspecifiedPART B
TX179285501Medicaid