Provider Demographics
NPI:1659841864
Name:COLLINS WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:COLLINS WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-544-8944
Mailing Address - Street 1:642 10TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-3446
Mailing Address - Country:US
Mailing Address - Phone:844-544-8944
Mailing Address - Fax:844-544-8944
Practice Address - Street 1:642 10TH ST STE 102
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3446
Practice Address - Country:US
Practice Address - Phone:844-544-8944
Practice Address - Fax:844-544-8944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1730186958Medicaid