Provider Demographics
NPI:1669097028
Name:COLLIER SHOT CORP
Entity type:Organization
Organization Name:COLLIER SHOT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-622-9360
Mailing Address - Street 1:177 E MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3885
Mailing Address - Country:US
Mailing Address - Phone:615-622-9362
Mailing Address - Fax:
Practice Address - Street 1:177 E MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3885
Practice Address - Country:US
Practice Address - Phone:615-622-9362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care