Provider Demographics
NPI:1730471939
Name:MADISON HMA PHYSICIAN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:MADISON HMA PHYSICIAN MANAGEMENT, LLC
Other - Org Name:FLORA FAMILY PHYSICIANS
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:34108-2733
Mailing Address - Country:US
Mailing Address - Phone:239-598-3131
Mailing Address - Fax:239-592-0438
Practice Address - Street 1:740 HIGHWAY 49
Practice Address - Street 2:SUITE V
Practice Address - City:FLORA
Practice Address - State:MS
Practice Address - Zip Code:39071
Practice Address - Country:US
Practice Address - Phone:601-879-8882
Practice Address - Fax:601-879-8485
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH MANAGEMENT ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-05
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC03614Medicare PIN