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  7. NPI Record 1235946716

COLLIER HEALTH SERVICES INC
Complete NPI Record 1235946716
Clinic/Center - Federally Qualified Health Center (FQHC) in Immokalee, FL

NPI Status: Active since December 17, 2024

Contact Information

1454 MADISON AVE W UNIT 4
IMMOKALEE, FL
ZIP 34142
Phone: (239) 658-3000

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider First Line Business Practice Location Address
  12. Provider Business Practice Location Address City Name
  13. Provider Business Practice Location Address State Name
  14. Provider Business Practice Location Address Postal Code
  15. Provider Business Practice Location Address Country Code If outside U S
  16. Provider Business Practice Location Address Telephone Number
  17. Provider Enumeration Date
  18. Last Update Date
  19. Authorized Official Last Name
  20. Authorized Official First Name
  21. Authorized Official Title or Position
  22. Authorized Official Telephone Number
  23. Healthcare Provider Taxonomy Code 1
  24. Healthcare Provider Primary Taxonomy Switch 1
  25. Is Organization Subpart
  26. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1235946716. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1235946716
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The last name of the provider. If the provider is an individual, this is the legal name.
The first name of the provider, if the provider is an individual.
Provider First Line Business Mailing Address: 1454 MADISON AVE W
The middle name of the provider, if the provider is an individual.
Provider Business Mailing Address City Name: IMMOKALEE
Other last name by which the provider being identified is or has been known.
Provider Business Mailing Address State Name: FL
Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider first name’’ if the provider is or has been known by a different last name only.
Provider Business Mailing Address Postal Code: 341422200
Other middle name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider middle name’’ if the provider is or has been known by a different last name only.
Provider Business Mailing Address Country Code If outside U S : US
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider Business Mailing Address Telephone Number: 2396583000
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider First Line Business Practice Location Address: 1454 MADISON AVE W UNIT 4
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: IMMOKALEE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: FL
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 341422200
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Practice Location Address Country Code If outside U S : US
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address Telephone Number: 2396583000
The city name in the location address of the provider being identified.
Provider Enumeration Date: 12/17/2024
The State code in the location of the provider being identified.
Last Update Date: 12/17/2024
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Authorized Official Last Name: RAZNOFF
The country code in the location address of the provider being identified.
Authorized Official First Name: TAMI
The telephone number associated with the location address of the provider being identified.
Authorized Official Title or Position: CFO
The title or position of the authorized official.
Authorized Official Telephone Number: 2399860136
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 261QF0400X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N
NPI Certification Date: 12/17/2024