NPIMap

Organization Active NPI

Collom & Carney Clinic Association

Doing business as Collom and Carney Clinic

  • Family Medicine Physician
  • Texarkana, TX
National Provider Identifier
1285616805
Registry record updated Sep 23, 2025
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
5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Phone
(903) 614-3000
Fax
(903) 614-3525
NPI assigned
Nov 18, 2005
Last updated
Sep 23, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
COLLOM & CARNEY CLINIC ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 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
Coo
Phone
(903) 614-3282

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X TX Primary

Addresses

Primary practice location

5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766

Mailing address

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

Other practice location 1

305 N William St
Atlanta, TX 75551-2300
Phone (903) 614-3000

Other practice location 2

815 N Kings Hwy
Wake Village, TX 75501-5700
Phone (903) 614-3000

Other practice location 3

128 N Ellis St
New Boston, TX 75570-2904
Phone (903) 614-3000

Other practice location 4

2014 Galleria Oaks Dr
Texarkana, TX 75503-4620
Phone (903) 614-3000

Other practice location 5

2931 Richmond Rd
Texarkana, TX 75503-2125
Phone (903) 614-3000

Other identifiers 2

IdentifierTypeStateIssuer
CU0435OtherTXRAILROAD MEDICARE
082241301MedicaidTX

Other names 1

  • Collom and Carney Clinic Doing business as

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

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 Carney Clinic

Locations

305 N William St
Atlanta, TX 75551
Phone (903) 614-3630

1408 College Dr
Texarkana, TX 75503
Phone (903) 791-1110

815 N Kings Hwy
Wake Village, TX 75501
Phone (903) 614-3700

Practitioners & affiliated clinicians

Practitioners 23

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 23

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": "1758585600000",
    "number": "1285616805",
    "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": "755039766",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "305 N William St",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "TX",
            "postal_code": "755512300",
            "country_code": "US",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "815 N Kings Hwy",
            "address_purpose": "LOCATION",
            "city": "Wake Village",
            "state": "TX",
            "postal_code": "755015700",
            "country_code": "US",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "128 N Ellis St",
            "address_purpose": "LOCATION",
            "city": "New Boston",
            "state": "TX",
            "postal_code": "755702904",
            "country_code": "US",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2014 Galleria Oaks Dr",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755034620",
            "country_code": "US",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2931 Richmond Rd",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755032125",
            "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 & CARNEY CLINIC ASSOCIATION",
        "enumeration_date": "2005-11-18",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A",
        "authorized_official_last_name": "DWIGHT",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "903-614-3282",
        "authorized_official_credential": "CCS-P, MHA, CMPE"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "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": "082241301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collom and Carney Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 23, 2025; 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.