Collier Health Services Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Immokalee, FL
NPI 1508079245 · NPPES record last updated Oct 16, 2024
Key facts
- NPI
- 1508079245
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COLLIER HEALTH SERVICES INC
- Practice address
- 508 N 9TH St
Suite 142
Immokalee, FL 34142-3146 - Phone
- (239) 658-3000
- Fax
- (239) 657-1612
- NPI assigned
- May 8, 2007
- Organization subpart
- No
Authorized official
- Name
- Tami Raznoff
- Title
- Cfo
- Phone
- (239) 986-0136
Other NPIs with the same Medicare PAC ID 24
Corporate family (same tax ID) 24
Practitioners 95
-
Amelia Francine Bell-Hawkins, APRN-BC, CRNP-F
-
Ruby Ann Cannon, DNP
-
Lawrence James Egger, PA9108319
-
Antonio Gonzalez, M.D
-
Marlene Gonzalez, M.D.
-
Amy Megan Iannone, APRN
-
Ludmilla Gabriel Joseph, APRN
-
Marie Danielle Joseph, FNP-C
-
Jaimenee Khemraj, M.D.
-
Ralph J. Martin, M.D.
-
Leonardo Mastache, APRN
-
Rylan McQuade, DO
-
Jean Kesnold Mesidor, PHD
-
Odalys Pena, ARNP
-
Norma B. Simpson, CNM
-
Sabia St Fleur, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Federally qualified health center certification: CCN 101822
- Legal name
- COLLIER HEALTH SERVICES, INC
- Doing business as
- FAMILY CARE ITECH
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 24, 2008
- Last certification
- Sep 24, 2008
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 17, 1977 in FL
- Enrollment address
- 508 N 9TH St
Unit 142
Immokalee, FL 34142-2948
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Jamie Ulmer |
Corporate Officer |
Jan 1, 2024 | |
| Haris Domond |
Corporate Director |
Apr 17, 2012 | 100% |
| Kerri Ervin |
Corporate Director |
Jun 24, 2021 | 100% |
| Maria Munguia |
Corporate Director |
Jan 1, 2024 | |
| John Fletcher |
Corporate Officer |
Oct 18, 2021 | 100% |
| Tami Raznoff |
Corporate Officer |
May 1, 2019 | 100% |
| W-2 Managing Employee |
May 1, 2019 | 100% | |
| Dennis Brown |
Corporate Director |
Jul 31, 2019 | 100% |
| Suzanne Bradach |
Corporate Director |
Sep 27, 2018 | 100% |
| Jean Casnel Paul |
Corporate Director |
Nov 27, 2007 | 100% |
| Alejandro Castano |
Corporate Director |
Jul 22, 2021 | 100% |
| Jerry Starkey |
Corporate Director |
Apr 17, 2014 | |
| James Douglas Campbell |
Corporate Director |
Jun 21, 2011 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080805000596 | FL | Part a Provider - Federally Qualified Health Center (FQHC) | 4183521925 | Practice locations: Immokalee, FL |
National Provider Directory
- Tax ID family
- Collier Health Services Central Naples Pediatrics
Locations
1441 Heritage Blvd
Immokalee, FL 34142
Phone (239) 624-8050
9160 Galleria Ct
Naples, FL 34109
Phone (239) 514-8787
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
508 N 9TH St
Suite 142
Immokalee, FL 34142-3146
Mailing address
1454 Madison Ave W
Immokalee, FL 34142-2200
Phone (239) 658-3000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 029152810 | Medicaid | FL |
Other names
- Healthcare Network
Other providers in Immokalee, FL
- Collier Health Services Inc
- Collier Health Services Inc
- Collier Health Services Inc
- Collier Health Services Inc
- Collier Health Services Inc
- Collier Health Services Inc
- Collier Health Services Inc
- Collier Health Services Inc
- Collier Health Services Inc
- Collier Health Services Inc
All providers in Immokalee, FL · Federally Qualified Health Center (FQHC) in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.