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NPI Code Detail

MEDICARE: COLLIER HEALTH SERVICES INC

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
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

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

General Provider Information

NPI Number : 1528271012
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 : 12655 COLLIER BLVD
Second Line :
City : NAPLES
State : FL
Zip : 34116-4005
Country : US
Telephone Number : 239-658-3000
Fax Number :
Authorized Official
Title or Position : CFO
Name : TAMI RAZNOFF
Credential :
Telephone Number : 239-658-3137
Provider Enumeration Date : 05/08/2007
Last Update Date : 04/27/2020

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Directions to “COLLIER HEALTH SERVICES INC ” Practice Location

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