| Gulf Coast Hma Physician Management Llc | |
|
1370 E Venice Ave Ste 202 Venice FL 34285-9084 | |
| (941) 480-0500 | |
| (941) 480-9322 |
| Full Name | Gulf Coast Hma Physician Management Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1370 E Venice Ave Ste 202, 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 1370 E Venice Ave Ste 202 Venice FL 34285-9084 Ph: (941) 480-0500 |
| NPI Number | 1720651029 |
|---|---|
| Provider Enumeration Date | 07/23/2021 |
| Last Update Date | 03/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720651029 | NPI | - | NPPES |
| 277033450 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (* (Not Available)) | Secondary |
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