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Collier Health Services Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Naples, FL

NPI 1679124010 · NPPES record last updated Oct 16, 2024

Key facts

NPI
1679124010
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
COLLIER HEALTH SERVICES INC
Practice address
12655 Collier Blvd
Naples, FL 34116-4005
Phone
(239) 658-3000
NPI assigned
Sep 26, 2019
Organization subpart
No

Authorized official

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

Other NPIs with the same Medicare PAC ID 24

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

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 97

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 97

Medicare participation

Medicare fee-for-service enrollment
Enrolled in FL

Federally qualified health center certification: CCN 681172

Legal name
COLLIER HEALTH SERVICES, INC
Doing business as
HEALTHCARE NETWORK SW FL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 9, 2020
Last certification
Mar 9, 2020
Ownership / control type
For profit – partnership
Organization structure
Corporation · Non-profit
Enrollment address
12655 Collier Blvd
Naples, FL 34116-4005

All disclosed owners & managing parties 8

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 Officer
Ceo		 Jan 1, 2024
Kerri Ervin
Individual 		Corporate Director
Board Member		 Jun 24, 2021
Maria Munguia
Individual 		Corporate Director
Board Member		 Jan 1, 2024
John Fletcher
Individual 		Corporate Officer
Chief Operating Officer		 Oct 18, 2021 100%
Tami Raznoff
Individual 		Corporate Officer
Cfo		 Jan 1, 2020 100%
W-2 Managing Employee
Cfo		 Jan 1, 2020 100%
Dennis Brown
Individual 		Corporate Director
Board Member		 Jul 31, 2019
Suzanne Bradach
Individual 		Corporate Director
Board Member		 Sep 27, 2018
Jerry Starkey
Individual 		Corporate Director Jan 1, 2020

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20200309001778 FL Part a Provider - Federally Qualified Health Center (FQHC) 4183521925 Practice locations: Naples, FL

National Provider Directory

Tax ID family
Collier Health Services Central Naples Pediatrics (79 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

12655 Collier Blvd
Naples, FL 34116-4005

Mailing address

1454 Madison Ave W
Immokalee, FL 34142-2200
Phone (239) 658-3000

Other names

  • Healthcare Network Doing business as

Other providers in Naples, FL

All providers in Naples, FL · Federally Qualified Health Center (FQHC) in Florida

Sources for this page

Verify at the official NPI Registry.