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General NPI Number Information
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NPI Number | 1396182317
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Entity Type | Organization
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Legal Business Name | ESTATES MEDICAL CENTER, INC
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Dates
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Enumeration Date | 05/31/2013
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 13240 TAMIAMI TRL N STE 204
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City | NAPLES
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State | FL
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Zip | 34110-1626
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Country | US
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Telephone | 239-349-2500
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Fax | 239-349-2501
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Provider Business Mailing Address
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Address Line | 281 10TH AVE NW
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City | NAPLES
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State | FL
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Zip | 34120-2083
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Country | US
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Telephone | 239-641-6871
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARC E MCCOLLAUM
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Credential | PA-C
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Telephone | 239-641-6871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME36001
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License Number State | FL
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