Provider Demographics
NPI:1902201783
Name:COLLIER OTOLARYNGOLOGY HEARING CENTER
Entity type:Organization
Organization Name:COLLIER OTOLARYNGOLOGY HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-592-7212
Mailing Address - Street 1:1879 VETERANS PARK DR
Mailing Address - Street 2:STE. 1201
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0492
Mailing Address - Country:US
Mailing Address - Phone:239-592-7212
Mailing Address - Fax:
Practice Address - Street 1:1879 VETERANS PARK DR
Practice Address - Street 2:SUITE 1201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0492
Practice Address - Country:US
Practice Address - Phone:239-592-7212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESTYLE HEARING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1725231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty