Provider Demographics
NPI:1982933222
Name:PORT CHARLOTTE HMA LLC
Entity Type:Organization
Organization Name:PORT CHARLOTTE HMA LLC
Other - Org Name:PEACE RIVER NORTH PORT HEALTH PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP AND GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRY
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:239-598-3131
Mailing Address - Street 1:2500 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5000
Mailing Address - Country:US
Mailing Address - Phone:941-766-4125
Mailing Address - Fax:941-766-4140
Practice Address - Street 1:15121 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2711
Practice Address - Country:US
Practice Address - Phone:941-766-4125
Practice Address - Fax:941-766-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
100077Medicare Oscar/Certification