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General NPI Number Information
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NPI Number | 1447799945
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Entity Type | Organization
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Legal Business Name | CRYSTAL RIVER HMA PHYSICIAN MANAGEMENT LLC
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 5915 W GULF TO LAKE HWY
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-7565
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Country | US
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Telephone | 352-794-3872
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Fax | 352-794-3876
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Provider Business Mailing Address
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Address Line | PO BOX 689022
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City | FRANKLIN
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State | TN
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Zip | 37068-9022
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Country | US
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Telephone | 615-465-7000
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Fax |
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Authorized Official
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Title or Position | SR DIR ONBOARDING & PROV ENROLLMENT
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Name | JENNIFER L JACKSON
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Credential |
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Telephone | 615-465-3334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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