Provider Demographics
NPI:1720396864
Name:CROSSGATES HMA MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:CROSSGATES HMA MEDICAL GROUP, LLC
Other - Org Name:CARE PLUS PEDIATRICS CROSSGATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
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 1:348 CROSSGATES BLVD
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2700
Mailing Address - Country:US
Mailing Address - Phone:601-824-2360
Mailing Address - Fax:601-825-8829
Practice Address - Street 1:348 CROSSGATES BLVD
Practice Address - Street 2:SUITE 1500
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2700
Practice Address - Country:US
Practice Address - Phone:601-824-2360
Practice Address - Fax:601-825-8829
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH MANAGEMENT ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty