Provider Demographics
NPI:1407061310
Name:COLLIER HEALTH SERVICES INC
Entity Type:Organization
Organization Name:COLLIER HEALTH SERVICES INC
Other - Org Name:CREEKSIDE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-658-3003
Mailing Address - Street 1:1265 CREEKSIDE PKWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1936
Mailing Address - Country:US
Mailing Address - Phone:239-591-1755
Mailing Address - Fax:239-591-4393
Practice Address - Street 1:1265 CREEKSIDE PKWY
Practice Address - Street 2:SUITE 208
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1936
Practice Address - Country:US
Practice Address - Phone:239-591-1755
Practice Address - Fax:239-591-4393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL683955005Medicaid
FL683955005Medicaid