Provider Demographics
NPI:1851453039
Name:COLLINS, ROGER I (RRT)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:COLLINS
Suffix:I
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 HARRODSBURG RD STE 228
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3517
Mailing Address - Country:US
Mailing Address - Phone:859-229-5390
Mailing Address - Fax:859-373-8127
Practice Address - Street 1:2265 HARRODSBURG RD
Practice Address - Street 2:STE 228
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3500
Practice Address - Country:US
Practice Address - Phone:859-229-5390
Practice Address - Fax:859-373-8127
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0744227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1105430001Medicare PIN