Provider Demographics
NPI:1750637427
Name:DURANT HMA PHYSICIAN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:DURANT HMA PHYSICIAN MANAGEMENT, LLC
Other - Org Name:MEDICAL CENTER UROLOGY
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 1:1400 BRYAN DR
Practice Address - Street 2:SUITE 303
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2156
Practice Address - Country:US
Practice Address - Phone:580-931-2227
Practice Address - Fax:580-931-2057
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH MANAGEMENT ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-31
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK600522400Medicare PIN