1750472486 NPI number — WILLIAM MATTHEW COLLIER M.D.

Table of content: DR. MONA WELLER BIRK PHD, APN (NPI 1518032192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750472486 NPI number — WILLIAM MATTHEW COLLIER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLIER
Provider First Name:
WILLIAM
Provider Middle Name:
MATTHEW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLLIER
Provider Other First Name:
MATT
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1750472486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
795 EASTERN BYP
Provider Second Line Business Mailing Address:
MEDICAL BLDG.# 2 SUITE 5
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40475-2406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-624-2229
Provider Business Mailing Address Fax Number:
859-625-9458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
795 EASTERN BYP
Provider Second Line Business Practice Location Address:
MEDICAL BLDG.# 2 SUITE 5
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40475-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-624-2229
Provider Business Practice Location Address Fax Number:
859-625-9458
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  40492 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 40492 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000495871 . This is a "ANTHEM BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64128788 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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