Provider Demographics
NPI:1255673356
Name:FLOWOOD RIVER OAKS HMA MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:FLOWOOD RIVER OAKS HMA MEDICAL GROUP LLC
Other - Org Name:RIDGELAND FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GINGRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-598-3131
Mailing Address - Street 1:5811 PELICAN BAY BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2733
Mailing Address - Country:US
Mailing Address - Phone:239-598-3131
Mailing Address - Fax:239-592-0438
Practice Address - Street 1:305 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-3428
Practice Address - Country:US
Practice Address - Phone:239-598-3131
Practice Address - Fax:601-856-9994
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH MANAGEMENT ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302G707586Medicare PIN