Healthcare Provider Details

I. General information

NPI: 1396182317
Provider Name (Legal Business Name): ESTATES MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13240 TAMIAMI TRL N STE 204
NAPLES FL
34110-1626
US

IV. Provider business mailing address

281 10TH AVE NW
NAPLES FL
34120-2083
US

V. Phone/Fax

Practice location:
  • Phone: 239-349-2500
  • Fax: 239-349-2501
Mailing address:
  • Phone: 239-641-6871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME36001
License Number StateFL

VIII. Authorized Official

Name: MR. MARC E MCCOLLAUM
Title or Position: PRESIDENT
Credential: PA-C
Phone: 239-641-6871