Healthcare Provider Details

I. General information

NPI: 1295802445
Provider Name (Legal Business Name): COLLIER HMA PHYSICIAN MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 COLLIER BOULEVARD
NAPLES FL
34114
US

IV. Provider business mailing address

5811 PELICAN BAY BLVD SUITE 500
NAPLES FL
34108-2704
US

V. Phone/Fax

Practice location:
  • Phone: 239-348-4400
  • Fax:
Mailing address:
  • Phone: 239-598-3131
  • Fax: 239-598-9433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. STANLEY D MCLEMORE
Title or Position: SR. VICE PRESIDENT
Credential:
Phone: 239-598-3131