Provider Demographics
NPI:1467642363
Name:COLLIER SPORTS MEDICINE AND ORTHOPAEDIC CENTER PA
Entity Type:Organization
Organization Name:COLLIER SPORTS MEDICINE AND ORTHOPAEDIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-593-3500
Mailing Address - Street 1:1706 MEDICAL BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1417
Mailing Address - Country:US
Mailing Address - Phone:239-593-3500
Mailing Address - Fax:239-593-9163
Practice Address - Street 1:1706 MEDICAL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1400
Practice Address - Country:US
Practice Address - Phone:239-593-3500
Practice Address - Fax:239-593-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2720OtherMEDICARE GROUP
FLK2720OtherMEDICARE GROUP
FLF70927Medicare UPIN
FL32351BMedicare PIN