Provider Demographics
NPI:1013944552
Name:HYGEIA MEDICAL GROUP PA
Entity Type:Organization
Organization Name:HYGEIA MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ASTHANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-897-3097
Mailing Address - Street 1:1005 COLLEGE BLVD W
Mailing Address - Street 2:SUITE C
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1053
Mailing Address - Country:US
Mailing Address - Phone:850-678-3994
Mailing Address - Fax:850-678-7131
Practice Address - Street 1:1005 COLLEGE BLVD W
Practice Address - Street 2:SUITE C
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1053
Practice Address - Country:US
Practice Address - Phone:850-678-3994
Practice Address - Fax:850-678-7131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30965208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD50946Medicare UPIN