MEDICARE: BILOXI 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	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1083971626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BILOXI HMA PHYSICIAN MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	4000 MERIDIAN BLVD
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6325
Country	:	US
Telephone Number	:	615-465-7000
Fax Number	:	615-628-6877

Provider Business Practice Location Address
First Line	:	967 CEDAR LAKE RD
Second Line	:	SUITE B
City	:	BILOXI
State	:	MS
Zip	:	39532-2128
Country	:	US
Telephone Number	:	228-392-7760
Fax Number	:	228-392-7646

Authorized Official
Title or Position	:	SR. DIR PROV ENROLL ONBOARDING
Name	:	JENNIFER L JACKSON
Credential	:
Telephone Number	:	877-892-9815

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	01/24/2022

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