NPIMap

Organization Active NPI

Collom & Carney Clinic Association

  • Nephrology Physician
  • Texarkana, TX
National Provider Identifier
1265414635
Registry record updated Jul 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
COLLOM & CARNEY CLINIC ASSOCIATION
Practice address
5002 Cowhorn Creek Rd
Texarkana, TX 75503
Phone
(903) 614-3000
Fax
(903) 614-3525
NPI assigned
Nov 18, 2005
Last updated
Jul 1, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
COLLOM AND CARNEY CLINIC ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 1, 2025

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X TX Primary

Addresses

Primary practice location

5002 Cowhorn Creek Rd
Texarkana, TX 75503

Mailing address

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

Other practice location 1

1425 E Lincoln Rd
Idabel, OK 74745-7367
Phone (903) 614-3000

Other practice location 2

1301 E Lincoln Rd
Idabel, OK 74745-7300
Phone (903) 614-3000

Other practice location 3

1315 S Lynn Ln
Idabel, OK 74745-6845
Phone (903) 614-3000

Other identifiers 2

IdentifierTypeStateIssuer
CU0435OtherRAILROAD MEDICARE
82239701MedicaidTX

Other names 1

  • Collom and Carney Clinic Nephrology Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, OK2 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
O20160113002190 OK Part B Supplier - Clinic/Group Practice 1355249541 Receives reassigned benefits from 7 practitioners
Practice locations: Idabel, OK

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

National Provider Directory

National Provider Directory
Part of
Collom and Carney Clini

Locations

2001 S Main St
Ste 6
Hope, AR 71801
Phone (870) 722-2448

403 S Indian Rd
Idabel, OK 74745
Phone (580) 286-6688

606 Loop 59
Atlanta, TX 75551
Phone (903) 614-3601

7909 Fredericksburg Rd
Ste 150L
San Antonio, TX 78229
Phone (210) 521-7700

1002 Texas Blvd
Ste 501
Texarkana, TX 75501
Phone (903) 792-5005

1902 Moores Ln
Ste A
Texarkana, TX 75503
Phone (903) 614-3850

2602 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-6000

4800 Texas Blvd
Texarkana, TX 75503
Phone (903) 614-3600

515 W 12th St
Texarkana, TX 75501
Phone (903) 735-5000

5305 Summerhill Rd
Texarkana, TX 75503
Phone (903) 792-7151

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 60

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 60

NPI Registry JSON

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751328000000",
    "number": "1265414635",
    "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": "75503",
            "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": "75503",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1425 E Lincoln Rd",
            "address_purpose": "LOCATION",
            "city": "Idabel",
            "state": "OK",
            "postal_code": "747457367",
            "country_code": "US",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1301 E Lincoln Rd",
            "address_purpose": "LOCATION",
            "city": "Idabel",
            "state": "OK",
            "postal_code": "747457300",
            "country_code": "US",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1315 S Lynn Ln",
            "address_purpose": "LOCATION",
            "city": "Idabel",
            "state": "OK",
            "postal_code": "747456845",
            "country_code": "US",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COLLOM & CARNEY CLINIC ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLLOM AND CARNEY CLINIC ASSOCIATION",
        "enumeration_date": "2005-11-18",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "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": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CU0435",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "82239701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collom and Carney Clinic Nephrology",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Collom and Carney Clinic Nephrology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Texarkana, TX

Sources for this page

Verify at the official NPI Registry.