MEDICARE: MIDWEST CITY HMA PHYSICIAN MANAGEMENT, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
2	207L00000X	Anesthesiology Physician
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
4	363L00000X	Nurse Practitioner
5	207Q00000X	Family Medicine Physician
6	207X00000X	Orthopaedic Surgery Physician
7	213E00000X	Podiatrist
8	207RC0000X	Cardiovascular Disease Physician
9	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1952469439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST CITY HMA PHYSICIAN MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	5811 PELICAN BAY BLVD
Second Line	:	SUITE 500
City	:	NAPLES
State	:	FL
Zip	:	34108-2704
Country	:	US
Telephone Number	:	239-598-3131
Fax Number	:	239-592-0438

Provider Business Practice Location Address
First Line	:	2801 PARKLAWN DR
Second Line	:	SUITE404
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-4211
Country	:	US
Telephone Number	:	405-610-1677
Fax Number	:	405-733-1450

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	11/26/2012

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