Provider Demographics
NPI:1780667303
Name:W.L. COLLINS CORP.
Entity Type:Organization
Organization Name:W.L. COLLINS CORP.
Other - Org Name:COLLINS SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:BJORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:508-580-2825
Mailing Address - Street 1:165 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1821
Mailing Address - Country:US
Mailing Address - Phone:508-580-2825
Mailing Address - Fax:508-586-3058
Practice Address - Street 1:165 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1821
Practice Address - Country:US
Practice Address - Phone:508-580-2825
Practice Address - Fax:508-586-3058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1521683Medicaid
MA160954OtherBLUE CROSS/BLUE SHIELD
MA160954OtherBLUE CROSS/BLUE SHIELD