Ethan B Colliver, D.O.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

4641 Issued in WV

Practice address

122 12TH St
Princeton, WV 24740-2312

Phone

(304) 425-7127

Fax

(304) 487-7235

NPI assigned

Oct 24, 2007

Last updated

Oct 17, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA, WV2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physical Medicine and Rehabilitation

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Princeton Community Hospital Assn. Inc.Group PAC ID 3678482221, 174 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Princeton Community Hospital Assn Inc Hospital, Princeton, WV, CCN 510046
• Carilion Medical Center Hospital, Roanoke, VA, CCN 490024

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Princeton Community Hospital Assn Inc.

  dba Mercer Medical Group

  • Urology Physician
  • Princeton, WV
  • NPI 1093917643
  Medicare reassignment Care Compare group NPD
• Princeton Community Hospital Assn., Inc

  dba Bluefield Internal Medicine

  • Rural Health Clinic/Center
  • Bluefield, VA
  • NPI 1235446485
  NPD
• Princeton Community Hospital Assn. Inc.

  dba PCH Behavioral Health Center

  • Psychiatric Hospital Unit
  • Bluefield, WV
  • NPI 1619053329
  NPD (past)
• Buffalo Spine & Sports Medicine PC

  dba Buffalo Spine & Sports Institute

  • Physical Medicine & Rehabilitation Physician
  • Williamsville, NY
  • NPI 1770517765
  NPD (past)
• Southwest Virginia Orthopedic and Spine LLC

  • Orthopaedic Surgery Physician
  • Blacksburg, VA
  • NPI 1255431250
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Princeton Community Hospital Assn., Inc.

  • General Acute Care Hospital
  • Princeton, WV
  • NPI 1558313213
  Care Compare affiliation
• Carilion Medical Center

  dba Carilion Roanoke Memorial Hospital

  • General Acute Care Hospital
  • Roanoke, VA
  • NPI 1033102942
  Care Compare affiliation

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

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760659200000",
    "number": "1184803330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 12TH ST",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247402312",
            "telephone_number": "304-425-7127",
            "fax_number": "304-487-7235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 12TH ST",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247402312",
            "telephone_number": "304-425-7127",
            "fax_number": "304-487-7235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLIVER",
        "first_name": "ETHAN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-24",
        "last_updated": "2025-10-17",
        "certification_date": "2025-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "VA",
            "license": "0102202357",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WV",
            "license": "4641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Coleman, LPN
• Serena Coles
• Judy Justina Collins
• Steven Lee Collins, MA
• Susan Collins
• Ileta Combs
• Katelyn Combs
• Kristina Comer
• Trey Murphy Comer
• Community Action of South Eastern WV (Casewv)

• Physical Medicine & Rehabilitation Physician in Princeton, WV
• Providers in Princeton, WV by specialty
• Physical Medicine & Rehabilitation Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.