Healthcare Provider Details

I. General information

NPI: 1154538544
Provider Name (Legal Business Name): COLLIER ENDOSCOPY & SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3439 PINE RIDGE RD
NAPLES FL
34109-3884
US

IV. Provider business mailing address

3439 PINE RIDGE RD
NAPLES FL
34109-3884
US

V. Phone/Fax

Practice location:
  • Phone: 239-275-6678
  • Fax: 239-275-5216
Mailing address:
  • Phone: 239-593-9599
  • Fax: 239-593-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberAS14960420
License Number StateFL

VIII. Authorized Official

Name: MS. MEGAN ALESSANDRA EVETTS
Title or Position: BILLER
Credential:
Phone: 239-593-9599