MEDICARE: PUNTA GORDA 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	273R00000X	Psychiatric Hospital Unit

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	529	OTHER	FL	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659310985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUNTA GORDA HMA LLC

Provider Business Mailing Address
First Line	:	809 E MARION AVE
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3819
Country	:	US
Telephone Number	:	941-639-3131
Fax Number	:

Provider Business Practice Location Address
First Line	:	733 E OLYMPIA AVE
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3841
Country	:	US
Telephone Number	:	941-637-2474
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/DELEGATED OFFICIAL
Name	:	PAULA LALOR
Credential	:
Telephone Number	:	629-215-3953

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	12/14/2021

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