Collom and Carney Clinic Association
Organization Active NPI Neurology Physician · Texarkana, TX
NPI 1215918693 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1215918693
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Neurology Physician 2084N0400X
- Legal business name
- COLLOM AND CARNEY CLINIC ASSOCIATION
- Practice address
- 5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766 - Phone
- (903) 614-3000
- Fax
- (903) 614-3525
- NPI assigned
- Nov 10, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- COLLOM AND CARNEY CLINIC
Authorized official
- Name
- Mary E Dwight, CCS-P, MHA, CMPE
- Title
- Chief Operating Officer
- Phone
- (903) 614-3282
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 20
Practitioners 52
-
Brian Christian Alessi, M.D.
-
William Bowling, P.A
-
Brooke D Carr, PA-C
-
Sunni Barr Clements, APRN, FNP-BC
-
Rita D Collins, ACNP, APRN
-
Cara P Cook, FNP
-
Amy Karen Davis, FNP
-
Paul Richard Gardial, M.D.
-
Minh-Ly N Gaylor, MD
-
Blane A Graves, MD
-
Kyle Jordan Jones, FNP-C
-
Cheryl Ann Kite, ANP
-
Brandi Langdon, FNP
-
Jessie Liang, MD
-
Sara Leanne Miers, N.P.
-
Shannon Larie Mitchell, RN-ACNP
-
Timothy L Overlock, M.D.
-
Paul H Pappas, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- Nashville Dialysis Unit
Locations
1307 Trinity Blvd
Texarkana, AR 71854
Phone (870) 773-6467
305 N William St
Atlanta, TX 75551
Phone (903) 614-3630
222 N Centre St
De Kalb, TX 75559
Phone (903) 667-0433
128 N Ellis St
New Boston, TX 75570
Phone (903) 628-1104
5730 Summerhill Rd
Texarkana, TX 75503
Phone (430) 200-5864
1902 Moores Ln
Ste 1
Texarkana, TX 75503
815 N Kings Hwy
Wake Village, TX 75501
Phone (903) 614-3700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician |
2084N0400X | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CU0435 | Other | RAILROAD MEDICARE | |
| 082233001 | Medicaid | TX |
Other names
- Collom and Carney Clinic Neurology
Other providers in Texarkana, TX
- Collom & Carney Clinic Association
- Collom & Carney Clinic Association
- Collom & Carney Clinic Association
- Collom and Carney Clinic
- Collom and Carney Clinic
- Collom and Carney Clinic Association
- Collom and Carney Clinic Association
- Collom and Carney Clinic Association
- Collom and Carney Clinic Association
- Collom and Carney Clinic Association
All providers in Texarkana, TX · Neurology Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.