Provider Demographics
NPI:1376738690
Name:COLLIER HEALTH SERVICES INC
Entity Type:Organization
Organization Name:COLLIER HEALTH SERVICES INC
Other - Org Name:CHS-FSU PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:B
Authorized Official - Last Name:ARAGONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-658-3035
Mailing Address - Street 1:1441 HERITAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2260
Mailing Address - Country:US
Mailing Address - Phone:239-658-3000
Mailing Address - Fax:
Practice Address - Street 1:1441 HERITAGE BLVD
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-2260
Practice Address - Country:US
Practice Address - Phone:239-658-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL683955013Medicaid