Provider Demographics
NPI:1821233750
Name:WILLIAM M COLLINS
Entity type:Organization
Organization Name:WILLIAM M COLLINS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-633-4488
Mailing Address - Street 1:157 DORTON JENKINS HWY
Mailing Address - Street 2:
Mailing Address - City:JENKINS
Mailing Address - State:KY
Mailing Address - Zip Code:41537-8272
Mailing Address - Country:US
Mailing Address - Phone:606-639-4020
Mailing Address - Fax:606-639-4021
Practice Address - Street 1:157 DORTON-JENKINS HWY
Practice Address - Street 2:
Practice Address - City:JENKINS
Practice Address - State:KY
Practice Address - Zip Code:41537
Practice Address - Country:US
Practice Address - Phone:606-639-4020
Practice Address - Fax:606-639-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64233752Medicaid
00000059456OtherBLUE CROSS/ BLUE SHIELD
KY0763001Medicare PIN