Healthcare Provider Details

I. General information

NPI: 1942255724
Provider Name (Legal Business Name): AMORY HMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 EARL FRYE BLVD
AMORY MS
38821-5500
US

IV. Provider business mailing address

1105 EARL FRYE BLVD
AMORY MS
38821-5500
US

V. Phone/Fax

Practice location:
  • Phone: 662-256-6002
  • Fax: 662-256-6007
Mailing address:
  • Phone: 662-256-6002
  • Fax: 662-256-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number12074
License Number StateMS

VIII. Authorized Official

Name: LAURIE HOLTSFORD
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 615-465-7466