Organization
GULF COAST HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Gulf Coast HMA Physician Management LLC, GULF COAST MEDICAL GROUP
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
901 VENETIA BAY BLVD STE 350, VENICE, FL 34285-8052
(941) 483-7651
(941) 483-7699
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
—
—
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277033420
—
FL
Enumeration date
07/16/2021
Last updated
03/15/2022
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