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Organization
GULF COAST HMA PHYSICIAN MANAGEMENT LLC
Active
Organization
GULF COAST HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
GCMG INTERNAL MEDICINE AND PEDIATRICS, Gulf Coast HMA Physician Management LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
1370 E VENICE AVE STE 202, VENICE, FL 34285-9084
(941) 480-0500
(941) 480-9322
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277033450
—
FL
Enumeration date
07/23/2021
Last updated
03/15/2022
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