Provider Demographics
NPI:1710996756
Name:KEVIN J COLLINS MD PA
Entity Type:Organization
Organization Name:KEVIN J COLLINS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-945-1888
Mailing Address - Street 1:PO BOX 25618
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-5618
Mailing Address - Country:US
Mailing Address - Phone:501-945-1888
Mailing Address - Fax:501-945-4102
Practice Address - Street 1:3401 SPRINGHILL DR
Practice Address - Street 2:SUITE 460
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2924
Practice Address - Country:US
Practice Address - Phone:501-945-1888
Practice Address - Fax:501-945-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5F100OtherBCBS OF ARKANSAS
DC5021OtherRAILROAD MEDICARE
AR5F100Medicare ID - Type Unspecified