Individual ProviderE J CollinsStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address809 82nd Pkwy, Myrtle Beach, SC 29572-4607(843) 692-1595(910) 309-8067PECOS EnrollmentBased on the most recent information from CMS, provider E J Collins does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1124026240Provider TypeIndividualFull NameCollins, E JCredentialMDGenderMaleSole ProprietorYesEnumeration Date7/12/2005Last Updated3/29/2020Contact InformationPractice LocationPractice Address809 82nd Pkwy, Myrtle Beach, SC 29572-4607Phone(843) 692-1595FaxUnlisted FaxMailing LocationMailing Address5608 Firedrake Rd, Hope Mills, NC 28348-1949Phone(910) 309-8067FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerSouth CarolinaCode367500000XDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicense162214North CarolinaProvider IdentifiersIDDescriptionIssuerID8051861DescriptionMedicaidIssuerUnlistedNorth Carolina