Provider Demographics
NPI:1477693380
Name:WILLIAM M COLLINS
Entity Type:Organization
Organization Name:WILLIAM M COLLINS
Other - Org Name:COLLINS RURAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLAIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-633-4488
Mailing Address - Street 1:109 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-7351
Mailing Address - Country:US
Mailing Address - Phone:606-633-4488
Mailing Address - Fax:606-633-8383
Practice Address - Street 1:109 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858-7351
Practice Address - Country:US
Practice Address - Phone:606-633-4488
Practice Address - Fax:606-633-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23375261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35000983Medicaid
KY48720OtherATHEM BLUE
KY64233752OtherMEDICAID
KY48720OtherATHEM BLUE
KY1420601Medicare UPIN
KYC75604Medicare UPIN