Provider Demographics
NPI:1396182317
Name:ESTATES MEDICAL CENTER, INC
Entity type:Organization
Organization Name:ESTATES MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCOLLAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:239-641-6871
Mailing Address - Street 1:281 10TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-2083
Mailing Address - Country:US
Mailing Address - Phone:239-641-6871
Mailing Address - Fax:
Practice Address - Street 1:13240 TAMIAMI TRL N STE 204
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1626
Practice Address - Country:US
Practice Address - Phone:239-349-2500
Practice Address - Fax:239-349-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 133V00000X, 363A00000X, 363LF0000X
FLME36001208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty