| Gulf Coast Hma Physician Management Llc | |
|
2446 Laurel Rd E North Venice FL 34275-3204 | |
| (941) 218-6200 | |
| (941) 218-6182 |
| Full Name | Gulf Coast Hma Physician Management Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2446 Laurel Rd E, North Venice, Florida |
| Authorized Official Name and Position | Jennifer L Jackson (SR DIR PROV ENROLLMENT & ONBOARDING) |
| Authorized Official Contact | 6154653334 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulf Coast Hma Physician Management Llc Po Box 689022 Franklin TN 37068-9022 Ph: (615) 465-7211 | Gulf Coast Hma Physician Management Llc 2446 Laurel Rd E North Venice FL 34275-3204 Ph: (941) 218-6200 |
| NPI Number | 1518535137 |
|---|---|
| Provider Enumeration Date | 06/11/2021 |
| Last Update Date | 03/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518535137 | NPI | - | NPPES |
| 277033444 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
Premise Health Of Florida Medical Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3439 Technology Dr, North Venice, FL 34275 Phone: 941-486-0100 Fax: 941-488-8358 |