Provider Demographics
NPI:1437871761
Name:COLLINS ADVANCED WOUND & OSTOMY CARE, LLC
Entity Type:Organization
Organization Name:COLLINS ADVANCED WOUND & OSTOMY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER AND MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HABTOM
Authorized Official - Middle Name:LEGESE
Authorized Official - Last Name:TEWELDEBRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:469-238-4774
Mailing Address - Street 1:PO BOX 743842
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-3842
Mailing Address - Country:US
Mailing Address - Phone:469-238-4774
Mailing Address - Fax:
Practice Address - Street 1:9550 FOREST LN STE 745
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5905
Practice Address - Country:US
Practice Address - Phone:469-238-4774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty