MEDICARE: PASCO HERNANDO HMA PHYSICIAN MANAGEMENT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	208600000X	Surgery Physician
3	208000000X	Pediatrics Physician
4	207RP1001X	Pulmonary Disease Physician
5	207RG0100X	Gastroenterology Physician
6	207Q00000X	Family Medicine Physician
7	363A00000X	Physician Assistant
8	207RB0002X	Obesity Medicine (Internal Medicine) Physician
9	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00009	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003848359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASCO HERNANDO HMA PHYSICIAN MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	13933 17TH ST
Second Line	:	SUITE 101
City	:	DADE CITY
State	:	FL
Zip	:	33525-4604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13933 17TH ST
Second Line	:	SUITE 101
City	:	DADE CITY
State	:	FL
Zip	:	33525-4604
Country	:	US
Telephone Number	:	352-567-6763
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. MICHAEL A SWAW
Credential	:
Telephone Number	:	615-778-8076

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	01/19/2016

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