MEDICARE: COLLIER ENDOSCOPY & SURGERY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	AS14960420	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154538544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLIER ENDOSCOPY & SURGERY CENTER

Provider Business Mailing Address
First Line	:	3439 PINE RIDGE RD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-3884
Country	:	US
Telephone Number	:	239-593-9599
Fax Number	:	239-593-4099

Provider Business Practice Location Address
First Line	:	3439 PINE RIDGE RD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-3884
Country	:	US
Telephone Number	:	239-275-6678
Fax Number	:	239-275-5216

Authorized Official
Title or Position	:	BILLER
Name	:	MS. MEGAN ALESSANDRA EVETTS
Credential	:
Telephone Number	:	239-593-9599

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	12/14/2015

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