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DR JACKIE L MCCOLLUM, MD. P.C.
NPI 1174706808
Point of Service in Aurora, CO

Active since December 17, 2007CLIA 06D0895949 · Waiver
12101 E 2ND AVE, SUITE 105, AURORA, CO 80011(720) 535-6204(720) 949-0540 Get Directions Write a Review

NPPES record last updated: June 10, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr Jackie L Mccollum, Md. P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR JACKIE L MCCOLLUM, MD. P.C. (NPI 1174706808) is a healthcare organization registered as a point of service in Aurora, Colorado and active in the NPI registry since December 2007. The organization holds a CLIA Waiver certificate valid through December 20, 2026 and lists Jackie Lynne Mccollum, President, as its authorized official.

NPPES Registry Identity

NPI1174706808
Entity TypeOrganization
Primary Taxonomy305S00000X
Legal Business NameDR JACKIE L MCCOLLUM, MD. P.C.
Location Address12101 E 2ND AVE, SUITE 105Aurora, CO 80011-8327
Mailing Address12101 E 2nd Ave, Suite 105Aurora, CO 80011-8327 · (720) 535-6204
Phone(720) 535-6204
Fax(720) 949-0540
Organization SubpartNo
Authorized OfficialJackie Lynne MccollumPresident · (720) 535-6204
Enumeration DateDecember 17, 2007
Last NPPES UpdateJune 10, 2022
NPPES CertifiedJune 10, 2022
✔ NPI 1174706808 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPoint of ServiceManaged Care Organizations
Taxonomy Code305S00000X
License✔ Licensed in CO · 28393
Definition
This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost.
12101 E 2ND AVE, Aurora, CO 80011
Open in Google Maps ↗

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 06D0895949

Jackie L Mccollum, MD, PC · Aurora, CO
Active · expires Dec 20, 2026
CLIA Number06D0895949
Laboratory TypePhysician Office
Certificate Effective DateDecember 21, 2024
Certificate Expiration DateDecember 20, 2026
Laboratory DirectorJackie L. Mccollum
Laboratory Phone(720) 535-6204
Laboratory LocationJackie L Mccollum, MD, PC12101 E 2nd Ave, Ste 105, Aurora, CO 80011
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JAMES PINKNEY III
Counselor (Professional)
12101 E 2ND AVE, SUITE 101
AURORA, CO 80011
Arapahoe County (303) 909-9952
NILSMA MARSHALL LAC
Counselor (Addiction (Substance Use Disorder))
12101 E 2ND AVE, # 108
AURORA, CO 80011
Arapahoe County (720) 425-7955
DOMINIQUE CONDEVAUX LAC, LPC, MAC, NCC
Counselor (Addiction (Substance Use Disorder))
12101 E 2ND AVE, SUITE 201B
AURORA, CO 80011
Arapahoe County (303) 819-7788
DR. JULIE ELIZABETH HABERSTROH DDS
Dentist
12101 E 2ND AVE, SUITE 206
AURORA, CO 80011
Arapahoe County (303) 343-2161
MS. KATHY J KUNCE LCSW
Social Worker (Clinical)
12101 E 2ND AVE, STE 110
AURORA, CO 80011
Arapahoe County (303) 328-5197
MR. RANDALL SEAN CRAVEN LPC, CAC II
Counselor (Professional)
12101 E 2ND AVE, SUITE 203
AURORA, CO 80011
Arapahoe County (720) 331-4878
JENNIFER YOUNG M.A., GCDF
Counselor (Mental Health)
12101 E 2ND AVE, 203
AURORA, CO 80011
Arapahoe County (720) 233-6765
DR. LUCAS JOHNS ED.D, LPC
Counselor (Mental Health)
12101 E 2ND AVE
AURORA, CO 80011
Arapahoe County (303) 847-3554

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dr Jackie L Mccollum, MD. P.C.'s NPI number?

The NPI number for Dr Jackie L Mccollum, MD. P.C. is 1174706808. It was assigned to this organization in the NPPES registry on December 17, 2007.

Where is Dr Jackie L Mccollum, MD. P.C. located?

Dr Jackie L Mccollum, MD. P.C. is located at 12101 E 2nd Ave Suite 105, Aurora, CO 80011. The listed phone number is (720) 535-6204.

What is Dr Jackie L Mccollum, MD. P.C.'s specialty?

The primary specialty registered for this NPI is Point of Service with taxonomy code 305S00000X.

Does Dr Jackie L Mccollum, MD. P.C. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 06D0895949) is associated with this NPI, valid through December 20, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Dr Jackie L Mccollum, MD. P.C. was last updated on June 10, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.