NPIMap

Organization Active NPI

Collom & Carney Clinic Association

  • Pain Medicine (Anesthesiology) Physician
  • Texarkana, TX
National Provider Identifier
1962829747
Registry record updated Dec 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
COLLOM & CARNEY CLINIC ASSOCIATION
Practice address
1902 Moores LN Ste a
Texarkana, TX 75503-4610
Phone
(903) 614-3850
Fax
(903) 614-3525
NPI assigned
Mar 18, 2014
Last updated
Dec 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2024

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
Title
Chief Operating Officer
Phone
(903) 614-3282

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X NU Primary

Addresses

Primary practice location

1902 Moores LN Ste a
Texarkana, TX 75503-4610

Mailing address

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

Other practice location 1

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

Other names 1

  • Collom and Carney Clinic Anesthesia Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140903000156 TX Part B Supplier - Clinic/Group Practice 1355249541 Receives reassigned benefits from 1 practitioner
Practice locations: Texarkana, TX

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

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

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

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 78

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 78

NPI Registry JSON

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

{
    "created_epoch": "1395100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735257600000",
    "number": "1962829747",
    "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": "1902 MOORES LN STE A",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755034610",
            "telephone_number": "903-614-3850",
            "fax_number": "903-614-3525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5002 Cowhorn Creek Rd",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755039766",
            "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": "NO",
        "enumeration_date": "2014-03-18",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "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"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collom and Carney Clinic Anesthesia",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Collom and Carney Clinic Anesthesia",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Texarkana, TX

Sources for this page

Verify at the official NPI Registry.