| Port Charlotte Hma Physician Management Llc | |
|
25097 Olympia Ave Ste 107 Punta Gorda FL 33950-3914 | |
| (941) 205-2620 | |
| (941) 235-2347 |
| Full Name | Port Charlotte Hma Physician Management Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 25097 Olympia Ave Ste 107, Punta Gorda, Florida |
| Authorized Official Name and Position | Jennifer L Jackson (SR DIR PROV ENROLLMENT & ONBOARDING) |
| Authorized Official Contact | 6154653334 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Port Charlotte Hma Physician Management Llc Po Box 689022 Franklin TN 37068-9022 Ph: (615) 465-7211 | Port Charlotte Hma Physician Management Llc 25097 Olympia Ave Ste 107 Punta Gorda FL 33950-3914 Ph: (941) 205-2620 |
| NPI Number | 1265003537 |
|---|---|
| Provider Enumeration Date | 07/07/2021 |
| Last Update Date | 03/16/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265003537 | NPI | - | NPPES |
| PENDING | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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