Provider Demographics
NPI:1700935848
Name:COLLINS, MARK WAYNE (CPO, CPED)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:WAYNE
Last Name:COLLINS
Suffix:
Gender:M
Credentials:CPO, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 E RACE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4727
Mailing Address - Country:US
Mailing Address - Phone:501-388-1883
Mailing Address - Fax:
Practice Address - Street 1:2221 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4727
Practice Address - Country:US
Practice Address - Phone:501-388-1883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist