Provider Demographics
NPI:1942659537
Name:NEHDRA MCCOLLUM
Entity Type:Organization
Organization Name:NEHDRA MCCOLLUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEHDRA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:02/18/2016
Authorized Official - Phone:216-396-8203
Mailing Address - Street 1:5008 EAST 86 ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125
Mailing Address - Country:US
Mailing Address - Phone:216-396-8203
Mailing Address - Fax:
Practice Address - Street 1:5008 E 86TH ST
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2000
Practice Address - Country:US
Practice Address - Phone:216-396-8203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization