Provider Demographics
NPI:1578854378
Name:FT SMITH HMA PBC MANAGEMENT, LLC
Entity Type:Organization
Organization Name:FT SMITH HMA PBC MANAGEMENT, LLC
Other - Org Name:SPARKS PREFERRED CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
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
Mailing Address - Country:US
Mailing Address - Phone:239-598-3131
Mailing Address - Fax:239-592-0438
Practice Address - Street 1:5111 ROGERS AVE
Practice Address - Street 2:SUITE 40M
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2047
Practice Address - Country:US
Practice Address - Phone:479-709-7440
Practice Address - Fax:479-709-7441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH MANAGEMENT ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty