NPIMap

Organization Active NPI

Collier Health Services Inc

Doing business as Healthcare Network

  • Federally Qualified Health Center (FQHC)
  • Immokalee, FL
National Provider Identifier
1508079245
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COLLIER HEALTH SERVICES INC
Doing business as
Healthcare Network
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
Last updated
Oct 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tami Raznoff
Title
Cfo
Phone
(239) 986-0136

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

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 names 1

  • Healthcare Network Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080805000596 FL Part A Provider - Federally Qualified Health Center (FQHC) 4183521925 Practice locations: Immokalee, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508079245. Details of each certification follow.

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
CorporationNon-profit
Incorporated
May 17, 1977 in FL
Enrollment address
508 N 9TH St
Unit 142
Immokalee, FL 34142-2948

Other NPIs with the same Medicare PAC ID 24

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 24

National Provider Directory

National Provider Directory
Tax ID family
Collier Health Services Inc79 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jamie Ulmer Individual Corporate OfficerCeo Jan 1, 2024
Haris Domond Individual Corporate DirectorBoard Member Apr 17, 2012 100%
Kerri Ervin Individual Corporate DirectorBoard Member Jun 24, 2021 100%
Maria Munguia Individual Corporate DirectorBoard Member Jan 1, 2024
John Fletcher Individual Corporate OfficerChief Operating Officer Oct 18, 2021 100%
Tami Raznoff Individual Corporate OfficerChief Financial Officer May 1, 2019 100%
W-2 Managing EmployeeChief Financial Officer May 1, 2019 100%
Dennis Brown Individual Corporate DirectorBoard Member Jul 31, 2019 100%
Suzanne Bradach Individual Corporate DirectorBoard Member Sep 27, 2018 100%
Jean Casnel Paul Individual Corporate DirectorBoard Member Nov 27, 2007 100%
Alejandro Castano Individual Corporate DirectorBoard Member Jul 22, 2021 100%
Jerry Starkey Individual Corporate DirectorBoard Member Apr 17, 2014
James Douglas Campbell Individual Corporate DirectorBoard Member Jun 21, 2011 100%

Practitioners & affiliated clinicians

Practitioners 92

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 92

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1508079245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1454 MADISON AVE W",
            "city": "IMMOKALEE",
            "state": "FL",
            "postal_code": "341422200",
            "telephone_number": "239-658-3000",
            "fax_number": "239-657-1612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 N 9TH ST",
            "address_2": "SUITE 142",
            "city": "IMMOKALEE",
            "state": "FL",
            "postal_code": "341423146",
            "telephone_number": "239-658-3000",
            "fax_number": "239-657-1612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIER HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A",
        "authorized_official_last_name": "RAZNOFF",
        "authorized_official_first_name": "TAMI",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "239-986-0136"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthcare Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Immokalee, FL

Sources for this page

Verify at the official NPI Registry.