Nga Collard PSC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

23094 Issued in KY

Legal business name

NGA COLLARD PSC

Practice address

1239 Woodland Dr
Suite 105
Elizabethtown, KY 42701-2770

Phone

(270) 765-7676

Fax

(270) 982-9222

NPI assigned

Aug 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nga Collard, MD

Title

Physicianowner

Phone

(270) 765-7676

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187568000000",
    "number": "1104931336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1239 WOODLAND DR",
            "address_2": "SUITE 105",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012770",
            "telephone_number": "270-765-7676",
            "fax_number": "270-765-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1239 WOODLAND DR",
            "address_2": "SUITE 105",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012770",
            "telephone_number": "270-765-7676",
            "fax_number": "270-982-9222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NGA COLLARD PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2007-08-20",
        "status": "A",
        "authorized_official_last_name": "COLLARD",
        "authorized_official_first_name": "NGA",
        "authorized_official_title_or_position": "PHYSICIANOWNER",
        "authorized_official_telephone_number": "270-765-7676",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "23094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64331713",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65943649",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9590114600",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9500360400",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Elizabethtown, KY
• Providers in Elizabethtown, KY by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.