Provider Demographics
| NPI: | 1245282979 |
|---|---|
| Name: | COLLIER HMA PHYSICIAN MANAGEMENT LLC |
| Entity type: | Organization |
| Organization Name: | COLLIER HMA PHYSICIAN MANAGEMENT LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIR PROV ENROLLMENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | KRISTINA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MUSIC |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 877-892-9815 |
| Mailing Address - Street 1: | PO BOX 689022 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | FRANKLIN |
| Mailing Address - State: | TN |
| Mailing Address - Zip Code: | 37068-9022 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 877-848-1457 |
| Mailing Address - Fax: | 615-628-6877 |
| Practice Address - Street 1: | 6101 PINE RIDGE RD |
| Practice Address - Street 2: | |
| Practice Address - City: | NAPLES |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 34119-3900 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 239-348-4504 |
| Practice Address - Fax: | 239-348-4203 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-17 |
| Last Update Date: | 2025-07-24 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 152W00000X, 156FX1800X, 207N00000X, 207Q00000X, 207Y00000X, 207RC0000X, 207RG0300X, 208000000X, 207RP1001X, 207W00000X, 208600000X, 208800000X, 208M00000X, 208VP0000X | ||
| FL | 207R00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty | |
| No | 156FX1800X | Eye and Vision Services Providers | Technician/Technologist | Optician | Group - Multi-Specialty |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | Group - Multi-Specialty |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| FL | 275883100 | Medicaid | |
| FL | Q0033 | Medicare PIN |