Provider Demographics
NPI:1023120458
Name:GADSDEN HMA PHYSICIAN MANAGEMENT INC
Entity type:Organization
Organization Name:GADSDEN HMA PHYSICIAN MANAGEMENT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCLEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-598-3131
Mailing Address - Street 1:303 BAY ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5265
Mailing Address - Country:US
Mailing Address - Phone:256-546-4793
Mailing Address - Fax:256-546-4967
Practice Address - Street 1:303 BAY ST
Practice Address - Street 2:SUITE 301
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5265
Practice Address - Country:US
Practice Address - Phone:256-546-4793
Practice Address - Fax:256-546-4967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529932809Medicaid
ALL025Medicare PIN