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PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC NPI 1467129791


NPI Information

NPI: 1467129791
Provider Name: PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC

Doing Business As: PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC

Classification: Internal Medicine - 207RG0100X
Entity Type: Organization

Specialization: Gastroenterology

CLIA Number: 10D2030963

Address:
3440 TAMIAMI TRL UNIT 1
PORT CHARLOTTE, FL
ZIP 33952
Phone: (941) 258-9500
Get Directions

PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC is a gastroenterology internal medicine in Port Charlotte, FL. The provider is an internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC NPI is 1467129791. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Port Charlotte Hma Physician Management Llc.

The provider's business location address is:

3440 TAMIAMI TRL UNIT 1
PORT CHARLOTTE, FL
ZIP 33952-134
Phone: (941) 258-9500
Fax: (941) 258-9501

The provider's authorized official is Jennifer L Jackson .
The authorized official title is Sr Dir Prov Enrollment & Onboarding and has the following contact phone number (615) 465-3334.

The CLIA number assigned to this NPI record is 10D2030963 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/25/2021 and was last updated on 7/25/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207V00000XObstetrics & GynecologyNo
2363LX0001XNurse PractitionerObstetrics & GynecologyNo
3207RG0100XInternal MedicineGastroenterologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1PENDINGMEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.