Provider Demographics
NPI:1043536881
Name:AMORY HMA PHYSICIAN MGMT LLC
Entity Type:Organization
Organization Name:AMORY HMA PHYSICIAN MGMT LLC
Other - Org Name:AMORY ENT AND ALLERGY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-256-7112
Mailing Address - Street 1:1107 EARL FRYE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5519
Mailing Address - Country:US
Mailing Address - Phone:662-257-6792
Mailing Address - Fax:662-257-6795
Practice Address - Street 1:1107 EARL FRYE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5519
Practice Address - Country:US
Practice Address - Phone:662-257-6792
Practice Address - Fax:662-257-6795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20619207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03439592Medicaid
MSC03454Medicare PIN