Provider Demographics
NPI:1609969302
Name:HERNANDO HMA LLC
Entity Type:Organization
Organization Name:HERNANDO HMA LLC
Other - Org Name:HERNANDO ENDOSCOPY & SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMODAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KANURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-596-4999
Mailing Address - Street 1:12180 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613
Mailing Address - Country:US
Mailing Address - Phone:352-596-4999
Mailing Address - Fax:352-596-2769
Practice Address - Street 1:12180 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613
Practice Address - Country:US
Practice Address - Phone:352-596-4999
Practice Address - Fax:352-596-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1037261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6ATOtherBLUE CROSS BLUE SHIELD
FL003213900Medicaid
FL490003238OtherMEDICARE RAILROAD
FL593354295OtherUNITED HEALTHCARE OF FL
FL593354295OtherUNITED HEALTHCARE OF FL