Provider Demographics
NPI:1881021681
Name:HAWK HEALTH SYSTEMS LLC
Entity Type:Organization
Organization Name:HAWK HEALTH SYSTEMS LLC
Other - Org Name:MADISON LIFE SPRING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:III
Authorized Official - Credentials:PA-C
Authorized Official - Phone:850-973-9980
Mailing Address - Street 1:248 NE HANCOCK AVE
Mailing Address - Street 2:PO BOX 173
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-2560
Mailing Address - Country:US
Mailing Address - Phone:850-973-9980
Mailing Address - Fax:
Practice Address - Street 1:248 NE HANCOCK AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-2560
Practice Address - Country:US
Practice Address - Phone:850-973-9980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106677363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty