Provider Demographics
NPI:1063418671
Name:COLLINS BROS., INC.
Entity type:Organization
Organization Name:COLLINS BROS., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHET
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:903-597-6566
Mailing Address - Street 1:1318 S BECKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3322
Mailing Address - Country:US
Mailing Address - Phone:903-597-6566
Mailing Address - Fax:903-597-6582
Practice Address - Street 1:1318 S BECKHAM AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3322
Practice Address - Country:US
Practice Address - Phone:903-597-6566
Practice Address - Fax:903-597-6582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
WA335222Z00000X
WA1130225000000X
WA9676225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
Not Answered225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC08454607OtherCAROLE DAVENPORT EDI SUB.
TX530909OtherBCBS OF TX
TX530909OtherBCBS OF TX