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Organization

HERNANDO HMA LLC

Active
Other names
Hernando Endoscopy & Surgery Center
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DAMODAR KANURI (ADMINISTRATOR)
(352) 596-4999
Entity
Organization

Contact information

Practice address
12180 CORTEZ BLVD, BROOKSVILLE, FL 34613
(352) 596-4999
(352) 596-2769
Mailing address
12180 CORTEZ BLVD, BROOKSVILLE, FL 34613
(352) 596-4999
(352) 596-2769

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1037
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003213900
FL
01
490003238
MEDICARE RAILROAD
FL
01
593354295
UNITED HEALTHCARE OF FL
FL
01
6AT
BLUE CROSS BLUE SHIELD
FL
Enumeration date
10/02/2006
Last updated
02/14/2017
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