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General NPI Number Information
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NPI Number | 1558938134
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Entity Type | Organization
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Legal Business Name | GULF COAST HMA PHYSICIAN MANAGEMENT LLC
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Dates
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Enumeration Date | 06/10/2021
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 1211 JACARANDA BLVD
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City | VENICE
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State | FL
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Zip | 34292-4520
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Country | US
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Telephone | 941-882-7824
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Fax | 941-486-2823
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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 | 615-465-7211
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Fax | 615-628-6877
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Authorized Official
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Title or Position | SR DIR PRO ENROLLMENT & ONBOARDING
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) 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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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