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Collom & Carney Clinic Association

Organization Active NPI Hematology & Oncology Physician · Texarkana, TX

NPI 1114909934 · NPPES record last updated Jul 25, 2023

Key facts

NPI
1114909934
Entity type
Organization (NPI type 2)
Primary specialty
Hematology & Oncology Physician 207RH0003X
Legal business name
COLLOM & CARNEY CLINIC ASSOCIATION
Practice address
5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Phone
(903) 614-3000
Fax
(903) 614-3525
NPI assigned
Nov 17, 2005
Organization subpart
Yes
Parent organization (as reported)
COLLOM AND CARNEY CLINIC

Authorized official

Name
Roger A Hall
Title
Ceo Administrator
Phone
(903) 614-3281

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Practitioners 84

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 84

Medicare participation

Medicare fee-for-service enrollment
Enrolled in TX

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Onesource Home Care Inc
Longview, TX · CCN 679138		 Home health agency 5% Or Greater Indirect Ownership Interest (33.33%) Jun 1, 2020
Prime Care Hospice LLC
Longview, TX · CCN 741756		 Hospice 5% Or Greater Direct Ownership Interest (33.3%) Jul 19, 2019

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031226000046 TX Part B Supplier - Clinic/Group Practice 1355249541 Receives reassigned benefits from 48 practitioners
20 other NPIs on this enrollment
Practice locations: Texarkana, TX; Atlanta, TX; New Boston, TX

National Provider Directory

Part of
Nashville Dialysis Unit

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207RH0003X TX Yes

Addresses

Primary practice location

5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766

Mailing address

5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Phone (903) 614-3000

Other identifiers

IdentifierTypeStateIssuer
119849104MedicaidTX
CU0435OtherRAILROAD MEDICARE

Other names

  • Collom and Carney Clinic Doing business as

Other providers in Texarkana, TX

All providers in Texarkana, TX · Hematology & Oncology Physician in Texas

Sources for this page

Verify at the official NPI Registry.