Provider Demographics
NPI:1134272339
Name:STEPHEN E COLLIER MD PC
Entity type:Organization
Organization Name:STEPHEN E COLLIER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OR PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-668-4895
Mailing Address - Street 1:PO BOX 10266
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38308-0104
Mailing Address - Country:US
Mailing Address - Phone:731-668-4895
Mailing Address - Fax:
Practice Address - Street 1:215 BASCOM RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-8802
Practice Address - Country:US
Practice Address - Phone:731-668-4895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK526Medicare ID - Type UnspecifiedGROUP PROVIDER #