Organization
COLVIN MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS L COLVIN M.D. (OWNER)
(318) 435-6363
Entity
Organization
Contact information
Practice address
2106 LOOP RD STE A, WINNSBORO, LA 71295-3343
(318) 435-8020
Mailing address
2106 LOOP RD STE A, WINNSBORO, LA 71295-3343
(318) 435-6363
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
109859
LA
Other
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
Enumeration date
02/19/2007
Last updated
09/29/2022
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