Basic Information
| Provider Information | |||||||||
| NPI: | 1467430132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 VALLEY VIEW DR | ||||||||
| Address2: | |||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612656194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097623621 | ||||||||
| FaxNumber: | 3097623690 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 VALLEY VIEW DR | ||||||||
| Address2: | |||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612656152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097623621 | ||||||||
| FaxNumber: | 3097623690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 01/28/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | 036105513 | IL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XS0117X | 34355 | IA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XS0117X | G84500 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 05543 | 01 | WELLMARK | OTHER | 069908 | 01 | HEALTH ALLIANCE | OTHER | 200042561 | 01 | RR MEDICARE | OTHER | 97944 | 01 | WELLMARK | OTHER | 97945 | 01 | WELLMARK | OTHER | 8121085 | 01 | IL | BCBS | OTHER | IA0195 | 01 | JOHN DEERE FAMILY | OTHER | 0546747 | 05 | IA | MEDICAID | 193307 | 01 | IA HEALTH SOLUTIONS | OTHER | 036105513 | 05 | IL | MEDICAID | 234522 | 01 | MIDLANDS CHOICE | OTHER | IL0172 | 01 | JOHN DEERE FAMILY | OTHER | IL0171 | 01 | JOHN DEERE FAMILY | OTHER |