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1639122690

NPI Code Detail

MEDICARE: WILLIAMSON HMA PHYSICIAN MANAGEMENT LLC

MEDICARE: WILLIAMSON 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	2086S0129X	Vascular Surgery Physician
2	208800000X	Urology Physician
3	363A00000X	Physician Assistant
4	363L00000X	Nurse Practitioner
5	208600000X	Surgery Physician
6	367500000X	Certified Registered Nurse Anesthetist
7	207L00000X	Anesthesiology Physician
8	207RC0000X	Cardiovascular Disease Physician
9	207Y00000X	Otolaryngology Physician
10	208000000X	Pediatrics Physician
11	2085R0202X	Diagnostic Radiology Physician
12	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639122690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMSON HMA PHYSICIAN MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	859 ALDERSON ST
Second Line	:
City	:	WILLIAMSON
State	:	WV
Zip	:	25661-3215
Country	:	US
Telephone Number	:	304-235-2500
Fax Number	:	304-235-0538

Provider Business Practice Location Address
First Line	:	859 ALDERSON ST
Second Line	:
City	:	WILLIAMSON
State	:	WV
Zip	:	25661-3215
Country	:	US
Telephone Number	:	304-235-2500
Fax Number	:	304-235-4549

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MICHAEL L GINGRAS
Credential	:
Telephone Number	:	239-598-3131

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	05/03/2019

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1215007968 — JHANSI LANKA MD
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1740404375 — DR. MUNEEL ABBAS MD
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Directions to “WILLIAMSON HMA PHYSICIAN MANAGEMENT LLC ” Practice Location

Language	Start Address	Practice Location

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