Provider Demographics
NPI:1114172111
Name:KENNETT HMA PHYSICIAN MANAGEMENT, INC.
Entity Type:Organization
Organization Name:KENNETT HMA PHYSICIAN MANAGEMENT, INC.
Other - Org Name:KENNETT ANESTHESIA ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEACHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-888-8424
Mailing Address - Street 1:1231 1ST ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-2527
Mailing Address - Country:US
Mailing Address - Phone:573-888-8424
Mailing Address - Fax:573-888-2715
Practice Address - Street 1:1301 1ST ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-2525
Practice Address - Country:US
Practice Address - Phone:573-888-8424
Practice Address - Fax:573-888-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500451901Medicaid
MO500451901Medicaid