Provider Demographics
NPI:1992725766
Name:CLINICAL COLLEAGUES INC
Entity type:Organization
Organization Name:CLINICAL COLLEAGUES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUMWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-937-1810
Mailing Address - Street 1:PO BOX 824246
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-4246
Mailing Address - Country:US
Mailing Address - Phone:850-985-9180
Mailing Address - Fax:954-545-3497
Practice Address - Street 1:1250 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2551
Practice Address - Country:US
Practice Address - Phone:850-985-9180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UNKNOWN207L00000X
207L00000X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDD9442OtherRAILROAD MEDICARE
KS0000111416OtherBLUE CROSS
CO62722573Medicaid
NC017H6OtherBLUE CROSS
KS200545920AMedicaid
OHDF9541OtherRAILROAD MEDICARE
TX0058WXOtherBLUE CROSS
CODF3380OtherRAILROAD MEDICARE
OH2741920Medicaid
WA367500000XMedicaid
WV3810018161Medicaid
610822000OtherOWCP
NC8000340Medicaid
AR198604002Medicaid
MO1992725766Medicaid
GA890960628AMedicaid
WV002514190OtherMOUNTAIN STATE BLUE CROSS
NC5902297Medicaid
NCDD9442OtherRAILROAD MEDICARE
WV3810018161Medicaid
CO805897Medicare PIN
WAG8883875Medicare PIN
NCDD9442OtherRAILROAD MEDICARE
MO1992725766Medicaid
MOMA4419Medicare PIN
OHCL9368161Medicare PIN