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NPI Code Detail

MEDICARE: FT SMITH HMA PBC MANAGEMENT, LLC

MEDICARE: FT SMITH HMA PBC MANAGEMENT, 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
1363A00000XPhysician Assistant
2207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1891085221
Entity Type Code : Organization
Provider Name (Legal Business Name) : FT SMITH HMA PBC 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 : 239-592-0438
Provider Business Practice Location Address
First Line : 8600 S 36TH TER
Second Line :
City : FORT SMITH
State : AR
Zip : 72908-8768
Country : US
Telephone Number : 479-709-7473
Fax Number : 479-709-7466
Authorized Official
Title or Position : VICE PRESIDENT
Name : MR. MICHAEL L GINGRAS
Credential :
Telephone Number : 239-598-3131
Provider Enumeration Date : 04/19/2011
Last Update Date : 11/27/2012

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