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General NPI Number Information
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NPI Number | 1114905866
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Entity Type | Organization
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Legal Business Name | COLLIER SURGERY CENTER,LLP
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 800 GOODLETTE RD N SUITE #120
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City | NAPLES
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State | FL
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Zip | 34102-5400
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Country | US
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Telephone | 239-262-5757
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Fax | 239-262-6073
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Provider Business Mailing Address
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Address Line | 800 GOODLETTE RD N SUITE #120
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City | NAPLES
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State | FL
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Zip | 34102-5400
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Country | US
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Telephone | 239-262-5757
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Fax | 239-262-6073
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DAVID WAYNE DOUGLAS
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Credential | ADMINISTRATOR
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Telephone | 239-262-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 973
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License Number State | FL
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