Healthcare Provider Details

I. General information

NPI: 1982933222
Provider Name (Legal Business Name): PORT CHARLOTTE HMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15121 TAMIAMI TRL
NORTH PORT FL
34287-2711
US

IV. Provider business mailing address

2500 HARBOR BLVD
PORT CHARLOTTE FL
33952-5000
US

V. Phone/Fax

Practice location:
  • Phone: 941-766-4125
  • Fax: 941-766-4140
Mailing address:
  • Phone: 941-766-4125
  • Fax: 941-766-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY PARRY
Title or Position: SR VP AND GENERAL COUNSEL
Credential: ESQ
Phone: 239-598-3131