Organization
BRANDON HMA LLC
Active
Organization
BRANDON HMA LLC
Active
Other names
Crossgates River Oaks Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY PARRY ESQ (SR. VP AND GENERAL COUNSEL)
(239) 598-3176
Entity
Organization
Contact information
Practice address
350 CROSSGATES BLVD, BRANDON, MS 39042-2601
(601) 824-8583
Mailing address
350 CROSSGATES BLVD, BRANDON, MS 39042-2601
(601) 824-8583
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000019303
BLUE CROSS
MS
05
—
06638595
—
MS
Enumeration date
05/23/2007
Last updated
03/22/2010
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