NPIMap

Organization Active NPI

Collom & Carney Clinic Association

  • Clinical Medical Laboratory
  • Texarkana, TX
National Provider Identifier
1164405296
Registry record updated May 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
45D0659663 Issued in TX
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 22, 2005
Last updated
May 1, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
COLLOM & CARNEY CLINIC ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 1, 2026

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

Authorized official

Name
Dana Robyn Morton
Title
Director Contracting Credentialing
Phone
(903) 614-3283

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 45D0659663 TX Primary

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 3

IdentifierTypeStateIssuer
095197201MedicaidTX
143671709MedicaidAR
CU0435OtherTXRAILROAD MEDICARE

Other names 1

  • Collom & Carney Clinic Laboratory Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

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
This NPI is an additional NPI on the enrollment
Practice locations: Texarkana, TX; Atlanta, TX; New Boston, TX
O20081119000535 TX Part B Supplier - Independent Clinical Laboratory 1355249541 Practice locations: Texarkana, TX

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 20

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

View all 20

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0659663Collom & Carney Clinic Laboratory5002 Cowhorn Creek Rd, Texarkana, TX 75503AccreditationNov 6, 2027
45D2136836Diagnostic Clinic of Longview5002 Cowhorn Creek Rd 3Rd Floor Room 3157, Texarkana, TX 75503ComplianceSep 17, 2027

National Provider Directory

National Provider Directory
Part of
Collom and Carney Clini

Ownership & related parties

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 IncLongview, TX, CCN 679138 Home health agency 5% Or Greater Indirect Ownership Interest (33.33%) Jun 1, 2020
Prime Care Hospice LLCLongview, TX, CCN 741756 Hospice 5% Or Greater Direct Ownership Interest (33.3%) Jul 19, 2019

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 77

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 77

NPI Registry JSON

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777593600000",
    "number": "1164405296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5002 COWHORN CREEK RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755039766",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5002 COWHORN CREEK RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755039766",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLOM & CARNEY CLINIC ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLLOM & CARNEY CLINIC ASSOCIATION",
        "enumeration_date": "2005-11-22",
        "last_updated": "2026-05-01",
        "certification_date": "2026-05-01",
        "status": "A",
        "authorized_official_last_name": "MORTON",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "ROBYN",
        "authorized_official_title_or_position": "DIRECTOR CONTRACTING CREDENTIALING",
        "authorized_official_telephone_number": "903-614-3283"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TX",
            "license": "45D0659663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "095197201",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143671709",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CU0435",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collom & Carney Clinic Laboratory",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Collom & Carney Clinic Laboratory",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Texarkana, TX

Sources for this page

Verify at the official NPI Registry.