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NPI Code Detail

MEDICARE: FT SMITH HMA PBC MANAGEMENT, LLC

MEDICARE: FT SMITH HMA PBC MANAGEMENT, LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1053601476
Entity Type Code : Organization
Provider Name (Legal Business Name) : FT SMITH HMA PBC MANAGEMENT, LLC
Provider Business Mailing Address
First Line : 5811 PELICAN BAY BLVD
Second Line : SUITE 500
City : NAPLES
State : FL
Zip : 34108-2733
Country : US
Telephone Number : 239-598-3131
Fax Number : 239-592-0438
Provider Business Practice Location Address
First Line : 4700 KELLEY HWY
Second Line :
City : FORT SMITH
State : AR
Zip : 72904-5024
Country : US
Telephone Number : 479-573-7990
Fax Number : 479-573-7991
Authorized Official
Title or Position : VICE PRESIDENT
Name : MR. MICHAEL L GINGRAS
Credential :
Telephone Number : 239-598-3131
Provider Enumeration Date : 04/19/2011
Last Update Date : 11/27/2012

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Directions to “FT SMITH HMA PBC MANAGEMENT, LLC ” Practice Location

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