MEDICARE: FLOWOOD RIVER OAKS HMA MEDICAL GROUP, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1386887479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOWOOD RIVER OAKS HMA MEDICAL GROUP, 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	:	239-592-0438

Provider Business Practice Location Address
First Line	:	1220 N SHORE PKWY
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-6383
Country	:	US
Telephone Number	:	601-829-2939
Fax Number	:	601-829-2995

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

Provider Enumeration Date	:	04/20/2009
Last Update Date	:	11/27/2012

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