Provider Demographics
NPI:1215199286
Name:STATESVILLE HMA PHYSICIAN MANAGEMENT INC
Entity Type:Organization
Organization Name:STATESVILLE HMA PHYSICIAN MANAGEMENT INC
Other - Org Name:STATESVILLE ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCLEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-598-3131
Mailing Address - Street 1:5811 PELICAN BAY BLVD
Mailing Address - Street 2:STE 500
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2704
Mailing Address - Country:US
Mailing Address - Phone:239-598-3131
Mailing Address - Fax:239-598-9433
Practice Address - Street 1:340 SIGNAL HILL DR
Practice Address - Street 2:SUITE A
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-4483
Practice Address - Country:US
Practice Address - Phone:704-873-6065
Practice Address - Fax:704-873-6058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH MANAGEMENT ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-30
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200700675207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5948720001OtherDME