NPIMap

Organization Active NPI

Collom & Carney Clinic Association

  • Psychiatry Physician
  • Texarkana, TX
National Provider Identifier
1265413645
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
COLLOM & CARNEY CLINIC ASSOCIATION
Practice address
5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Phone
(903) 614-3800
Fax
(903) 794-1446
NPI assigned
Nov 11, 2005
Organization subpart
Yes
Parent organization
COLLOM AND CARNEY CLINICAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Mary E Dwight, CCS-P, MHA, CMPE
Title
Chief Operating Officer
Phone
(903) 614-3282

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.

Other NPIs on the same Medicare enrollment 20

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

View all 20

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

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

National Provider Directory

National Provider Directory
Part of
Nashville Dialysis Unit

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X TX Primary

Addresses

NPPES NPI Registry

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 2

NPPES NPI Registry
IdentifierTypeStateIssuer
CU0435OtherTXRAILROAD MEDICARE
084148801MedicaidTX

Other names 1

NPPES NPI Registry
  • Collom and Carney Clinic Psychiatry Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 5, 2024.

{
    "created_epoch": "1131667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1265413645",
    "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": "903-614-3800",
            "fax_number": "903-794-1446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLOM & CARNEY CLINIC ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLLOM AND CARNEY CLINIC",
        "enumeration_date": "2005-11-11",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "DWIGHT",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "903-614-3282",
        "authorized_official_credential": "CCS-P, MHA, CMPE"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CU0435",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084148801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collom and Carney Clinic Psychiatry",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Collom and Carney Clinic Psychiatry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Texarkana, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.