MEDICARE: KENNETT HMA 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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1265847982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETT HMA LLC

Provider Business Mailing Address
First Line	:	PO BOX 689022
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-9022
Country	:	US
Telephone Number	:	615-778-8532
Fax Number	:	615-628-6877

Provider Business Practice Location Address
First Line	:	509 SOUTH BYP
Second Line	:
City	:	KENNETT
State	:	MO
Zip	:	63857-3248
Country	:	US
Telephone Number	:	573-888-4310
Fax Number	:	573-888-0450

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

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	11/10/2016

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