Provider Demographics
NPI:1942255724
Name:AMORY HMA LLC
Entity Type:Organization
Organization Name:AMORY HMA LLC
Other - Org Name:MERIT HEALTH GILMORE MEMORIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:1105 EARL FRYE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5500
Mailing Address - Country:US
Mailing Address - Phone:662-256-6002
Mailing Address - Fax:662-256-6007
Practice Address - Street 1:1105 EARL FRYE BLVD
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5500
Practice Address - Country:US
Practice Address - Phone:662-256-6002
Practice Address - Fax:662-256-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
275N00000X
MS12074282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS20003OtherBLUE CROSS
AL186OtherBLUE CROSS
MS00020003Medicaid
MS20003OtherBLUE CROSS
MS00020003Medicaid