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General NPI Number Information
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NPI Number | 1578882643
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Entity Type | Organization
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Legal Business Name | LONE STAR HMA PHYSICIAN MANAGEMENT, INC
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 2704 N GALLOWAY AVE SUITE 103
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City | MESQUITE
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State | TX
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Zip | 75150-6378
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Country | US
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Telephone | 239-598-3131
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Fax | 239-592-0438
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Provider Business Mailing Address
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Address Line | 5811 PELICAN BAY BLVD SUITE 500
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City | NAPLES
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State | FL
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Zip | 34108-2733
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Country | US
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Telephone | 239-598-3131
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Fax | 239-592-0438
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. MICHAEL L GINGRAS
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Credential |
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Telephone | 239-598-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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 #3
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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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