Organization
GULF COAST HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Gulf Coast HMA Physician Management LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
836 SUNSET LAKE BLVD STE 102, VENICE, FL 34292-7555
(941) 497-1771
(941) 497-1860
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
09/03/2021
Last updated
03/14/2022
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