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Organization
PUNTA GORDA HMA PHYSICIAN MANAGEMENT LLC
Active
Organization
PUNTA GORDA HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Punta Gorda HMA Physician Management LLC, BHMG Primary Care
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
713 E MARION AVE STE 131, PUNTA GORDA, FL 33950-3868
(941) 575-1414
(941) 639-0466
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
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278522612
—
FL
Enumeration date
07/22/2021
Last updated
03/16/2022
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