Provider Demographics
NPI:1154538544
Name:COLLIER ENDOSCOPY & SURGERY CENTER
Entity type:Organization
Organization Name:COLLIER ENDOSCOPY & SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:ALESSANDRA
Authorized Official - Last Name:EVETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-593-9599
Mailing Address - Street 1:3439 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3884
Mailing Address - Country:US
Mailing Address - Phone:239-593-9599
Mailing Address - Fax:239-593-4099
Practice Address - Street 1:3439 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3884
Practice Address - Country:US
Practice Address - Phone:239-275-6678
Practice Address - Fax:239-275-5216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS14960420261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070928000Medicaid
FL070928000Medicaid