Provider Demographics
NPI:1003484890
Name:COLLIER HMA PHYSICIAN MANAGEMENT LLC
Entity Type:Organization
Organization Name:COLLIER HMA PHYSICIAN MANAGEMENT LLC
Other - Org Name:COLLIER HMA PHYSICIAN MANAGEMENT LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7377
Mailing Address - Street 1:8340 COLLIER BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-3589
Mailing Address - Country:US
Mailing Address - Phone:615-465-7211
Mailing Address - Fax:615-628-6877
Practice Address - Street 1:8340 COLLIER BLVD STE 202
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-3589
Practice Address - Country:US
Practice Address - Phone:239-348-4221
Practice Address - Fax:239-348-4213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275883127Medicaid