Organization
LIVE OAK HMA LLC
Active
Other names
Hamilton Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA LALOR (DIRECTOR/DELEGATED OFFICIAL)
(615) 925-4565
Entity
Organization
Contact information
Practice address
413 5TH AVE NW STE A, JASPER, FL 32052-7801
(386) 292-8132
(386) 792-7745
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 778-8196
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
4314
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016770200
—
FL
Enumeration date
09/09/2014
Last updated
10/16/2019
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