Provider Demographics
NPI:1528564911
Name:COLLIER HEALTH SERVICE, INC
Entity Type:Organization
Organization Name:COLLIER HEALTH SERVICE, INC
Other - Org Name:FAMILY CARE NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-658-3158
Mailing Address - Street 1:1454 MADISON AVE W
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2200
Mailing Address - Country:US
Mailing Address - Phone:239-658-3137
Mailing Address - Fax:239-658-3051
Practice Address - Street 1:1265 CREEKSIDE PKWY STE 206
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1954
Practice Address - Country:US
Practice Address - Phone:239-658-3710
Practice Address - Fax:239-591-2154
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLLIER HEALTH SERVICE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty