Provider Demographics
NPI:1083674519
Name:COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
Entity Type:Organization
Organization Name:COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
Other - Org Name:COLLIER COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TABATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-252-3780
Mailing Address - Street 1:PO BOX 7789
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34101-7789
Mailing Address - Country:US
Mailing Address - Phone:239-252-3754
Mailing Address - Fax:
Practice Address - Street 1:8075 LELY CULTURAL PARKWAY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-7789
Practice Address - Country:US
Practice Address - Phone:239-252-3740
Practice Address - Fax:239-252-3898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3140341600000X, 3416A0800X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL089707800Medicaid
FL099321200OtherMEDICAID AIR
FL590000001OtherRAILROAD PROVIDER ID
FL089707800Medicaid