MEDICARE: PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	207RG0100X	Gastroenterology Physician	FL
2	207V00000X	Obstetrics & Gynecology Physician	FL
3	207X00000X	Orthopaedic Surgery Physician	FL
4	207R00000X	Internal Medicine Physician	FL
5	2084N0400X	Neurology Physician
6	208600000X	Surgery Physician
7	207Q00000X	Family Medicine Physician	FL

General Provider Information

NPI Number	:	1003985573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	PO BOX 689022
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-9022
Country	:	US
Telephone Number	:	615-465-7211
Fax Number	:	615-628-6877

Provider Business Practice Location Address
First Line	:	713 E MARION AVE STE 121
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3862
Country	:	US
Telephone Number	:	941-833-1760
Fax Number	:	941-205-3374

Authorized Official
Title or Position	:	DIRECTOR PROVIDER ENROLLMENT
Name	:	KRISTINA MUSIC
Credential	:
Telephone Number	:	877-892-9815

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	09/02/2025

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