NPIMap

Organization Active NPI

Collom & Carney Clinic Association

Doing business as Collom and Carney Clinic

  • Family Medicine Physician
  • Texarkana, TX
National Provider Identifier
1285061648
Registry record updated Jul 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COLLOM & CARNEY CLINIC ASSOCIATION
Doing business as
Collom and Carney Clinic
Practice address
1408 College Dr
Texarkana, TX 75503-3534
Phone
(903) 794-0515
Fax
(903) 793-8000
NPI assigned
Oct 1, 2013
Last updated
Jul 25, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
COLLOM & CARNEY CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 25, 2023

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
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1408 College Dr
Texarkana, TX 75503-3534

Mailing address

5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Phone (903) 614-3000

Other names 2

  • Collom and Carney Clinic Doing business as
  • Collom and Carney Clinic College Drive Other name

National Provider Directory

National Provider Directory
Tax ID family
Collom and Carney Clini20 organizations share this tax ID, including this one
Part of
Collom and Carney Clini

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Ownership & related parties

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.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1380585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690243200000",
    "number": "1285061648",
    "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": "1408 COLLEGE DR",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755033534",
            "telephone_number": "903-794-0515",
            "fax_number": "903-793-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLOM & CARNEY CLINIC ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLLOM & CARNEY CLINIC",
        "enumeration_date": "2013-10-01",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collom and Carney Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Collom and Carney Clinic College Drive",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Collom and Carney Clinic College Drive",
            "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 Jul 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.