MEDICARE: LONE STAR HMA PHYSICIAN MANAGEMENT, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	208D00000X	General Practice Physician
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1578882643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONE STAR HMA PHYSICIAN MANAGEMENT, INC

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	:	2704 N GALLOWAY AVE
Second Line	:	SUITE 103
City	:	MESQUITE
State	:	TX
Zip	:	75150-6378
Country	:	US
Telephone Number	:	239-598-3131
Fax Number	:	239-592-0438

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

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	11/26/2012

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