Provider Demographics
NPI:1083971626
Name:BILOXI HMA PHYSICIAN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:BILOXI HMA PHYSICIAN MANAGEMENT, LLC
Other - Org Name:INTERNAL MEDICINE AT CEDAR LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIR PROV ENROLL ONBOARDING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9815
Mailing Address - Street 1:4000 MERIDIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6325
Mailing Address - Country:US
Mailing Address - Phone:615-465-7000
Mailing Address - Fax:615-628-6877
Practice Address - Street 1:967 CEDAR LAKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2128
Practice Address - Country:US
Practice Address - Phone:228-392-7760
Practice Address - Fax:228-392-7646
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH MANAGEMENT ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-20
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSCO3540Medicare PIN