Organization
GULF COAST HMA PHYSICIAN MANAGEMENT LLC
Active
Organization
GULF COAST HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Restore Medical Partners LLC, Gulf Coast 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
333 TAMIAMI TRL S STE 101, VENICE, FL 34285-2425
(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
207L00000X
Anesthesiology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
225200000X
Physical Therapy Assistant
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277033424
—
FL
Enumeration date
07/14/2021
Last updated
03/15/2022
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