Provider Demographics
NPI:1114905866
Name:COLLIER SURGERY CENTER,LLP
Entity Type:Organization
Organization Name:COLLIER SURGERY CENTER,LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:239-262-5757
Mailing Address - Street 1:800 GOODLETTE RD N
Mailing Address - Street 2:SUITE #120
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5400
Mailing Address - Country:US
Mailing Address - Phone:239-262-5757
Mailing Address - Fax:239-262-6073
Practice Address - Street 1:800 GOODLETTE RD N
Practice Address - Street 2:SUITE #120
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5400
Practice Address - Country:US
Practice Address - Phone:239-262-5757
Practice Address - Fax:239-262-6073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL973261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61SOtherBCBS OF FLORIDA
FLF1151Medicare ID - Type Unspecified