MEDICARE: BARTOW HMA PHYSICIAN MANAGEMENT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	208600000X	Surgery Physician
2	2086S0129X	Vascular Surgery Physician
3	208800000X	Urology Physician

General Provider Information

NPI Number	:	1275622995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARTOW HMA PHYSICIAN MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	5811 PELICAN BAY BLVD
Second Line	:	SUITE 500
City	:	NAPLES
State	:	FL
Zip	:	34108-2733
Country	:	US
Telephone Number	:	239-598-3131
Fax Number	:	239-598-9433

Provider Business Practice Location Address
First Line	:	3644 INNOVATION DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33812-4105
Country	:	US
Telephone Number	:	863-701-2053
Fax Number	:	863-646-5834

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MICHAEL L GINGRAS
Credential	:
Telephone Number	:	239-598-3131

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	11/26/2012

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