Provider Demographics
NPI:1457370363
Name:COLLINS, NEAL W (PA-C)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:W
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5763
Mailing Address - Fax:740-446-5573
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:855-446-5387
Practice Address - Fax:740-446-5153
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50000806363AM0700X
WV158363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0106595Medicaid
OH310917085100OtherCARESOURCE MEDICAID
OH000000181957OtherUNISON MEDICAID
970003254OtherRR MEDICARE
OHPA10304Medicare PIN