# COLVIN MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023152352
- **Authorized official:** THOMAS L COLVIN M.D. (OWNER)
- **Authorized official phone:** (318) 435-6363

## Contact information

- **Practice address:** 2106 LOOP RD STE A, WINNSBORO, LA 71295-3343
- **Practice address phone:** (318) 435-8020
- **Mailing address:** 2106 LOOP RD STE A, WINNSBORO, LA 71295-3343
- **Mailing address phone:** (318) 435-6363

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 109859 | LA | Yes |

## Other

- **Enumeration date:** 02/19/2007
- **Last updated:** 09/29/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1449571 | — | LA |
| 01 | — | 1982670733 | INDIVIDUAL NPI NUMBER | LA |
| 01 | — | 4371062 | AETNA PROVIDER NUMBER | LA |
| 01 | — | 439928784A | BCBS OF LA PROVIDER NO | LA |
| 01 | — | L92021 | VANTAGE PROVIDER NO | LA |