Provider Demographics
NPI:1295802445
Name:COLLIER HMA PHYSICIAN MANAGEMENT, INC
Entity type:Organization
Organization Name:COLLIER HMA PHYSICIAN MANAGEMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCLEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-598-3131
Mailing Address - Street 1:5811 PELICAN BAY BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2704
Mailing Address - Country:US
Mailing Address - Phone:239-598-3131
Mailing Address - Fax:239-598-9433
Practice Address - Street 1:8340 COLLIER BOULEVARD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114
Practice Address - Country:US
Practice Address - Phone:239-348-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH MANAGEMENT ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-30
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275883100Medicaid
FL275883100Medicaid