Provider Demographics
NPI:1467430132
Name:COLLINS, RICHARD S (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6194
Mailing Address - Country:US
Mailing Address - Phone:309-762-3621
Mailing Address - Fax:309-762-3690
Practice Address - Street 1:520 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6152
Practice Address - Country:US
Practice Address - Phone:309-762-3621
Practice Address - Fax:309-762-3690
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105513207XS0117X
IA34355207XS0117X
CAG84500207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
05543OtherWELLMARK
069908OtherHEALTH ALLIANCE
200042561OtherRR MEDICARE
97944OtherWELLMARK
97945OtherWELLMARK
IL8121085OtherBCBS
IA0195OtherJOHN DEERE FAMILY
IA0546747Medicaid
193307OtherIA HEALTH SOLUTIONS
IL036105513Medicaid
234522OtherMIDLANDS CHOICE
IL0172OtherJOHN DEERE FAMILY
IL0171OtherJOHN DEERE FAMILY
05543OtherWELLMARK
069908OtherHEALTH ALLIANCE
97944OtherWELLMARK