MEDICARE: COLLIER HEALTH SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134334048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLIER HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	1454 MADISON AVE W
Second Line	:
City	:	IMMOKALEE
State	:	FL
Zip	:	34142-2200
Country	:	US
Telephone Number	:	239-658-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6350 DAVIS BLVD # 1001
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34104-5323
Country	:	US
Telephone Number	:	239-658-3000
Fax Number	:	239-775-9363

Authorized Official
Title or Position	:	CFO
Name	:	TAMI RAZNOFF
Credential	:
Telephone Number	:	239-986-0136

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	10/16/2024

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Directions to “COLLIER HEALTH SERVICES INC ” Practice Location

Language	Start Address	Practice Location

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