1669520409 NPI number — COLLIER EMERGENCY SPECIALISTS LLC

Table of content: (NPI 1669520409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669520409 NPI number — COLLIER EMERGENCY SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLLIER EMERGENCY SPECIALISTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669520409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 GILL ST
Provider Second Line Business Mailing Address:
STE 3000
Provider Business Mailing Address City Name:
WOBURN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01801-1728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-937-4522
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8300 COLLIER BLVD
Provider Second Line Business Practice Location Address:
PHYSICIAN'S REGIONAL MEDICAL CENTER - COLLIER BLVD
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34114-3549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-354-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ABOOD
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
239-593-3232

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 277495000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99345 . This is a "BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".