NPIMap

Organization Active NPI

Collom & Carney Clinic Association

  • Family Medicine Physician
  • New Boston, TX
National Provider Identifier
1700100104
Registry record updated Feb 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COLLOM & CARNEY CLINIC ASSOCIATION
Practice address
128 N Ellis St
New Boston, TX 75570-2904
Phone
(903) 628-1104
Fax
(903) 628-0104
NPI assigned
Mar 15, 2010
Organization subpart
Yes
Parent organization
COLLOM & CARNEY CLINIC ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 24, 2023

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

128 N Ellis St
New Boston, TX 75570-2904

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
Nashville Dialysis Unit20 organizations share this tax ID, including this one
Part of
Nashville Dialysis Unit

Other organizations with this tax ID 19

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

View all 19

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1268611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677196800000",
    "number": "1700100104",
    "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": "128 N ELLIS ST",
            "city": "NEW BOSTON",
            "state": "TX",
            "postal_code": "755702904",
            "telephone_number": "903-628-1104",
            "fax_number": "903-628-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLOM & CARNEY CLINIC ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLLOM & CARNEY CLINIC ASSOCIATION",
        "enumeration_date": "2010-03-15",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "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": "MHA, CCS-P, CMPE"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Boston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 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.