Provider Demographics
NPI:1437901642
Name:BENJAMIN MCCOLLUM MD PLLC
Entity Type:Organization
Organization Name:BENJAMIN MCCOLLUM MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTACTING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-400-0270
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861-0335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 AVENUE E
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861-3534
Practice Address - Country:US
Practice Address - Phone:830-426-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty