Organization
CRYSTAL RIVER HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Crystal River 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
2456 N ESSEX AVE, HERNANDO, FL 34442-5321
(352) 513-4783
(352) 513-4810
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
08/19/2021
Last updated
05/04/2023
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