1902886013 NPI number — HAMLET HMA PHYSICIAN MANAGEMENT, LLC

Table of content: (NPI 1902886013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902886013 NPI number — HAMLET HMA PHYSICIAN MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMLET HMA PHYSICIAN MANAGEMENT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SANDHILLS MEDICAL GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902886013
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5811 PELICAN BAY BLVD
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34108-2704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-598-3131
Provider Business Mailing Address Fax Number:
239-598-9433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMLET
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28345-3322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-205-0400
Provider Business Practice Location Address Fax Number:
910-205-7796
Provider Enumeration Date:
01/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCLEMORE
Authorized Official First Name:
STANLEY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
239-598-3131

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  21758 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 19375 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 32811 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X , with the licence number: 2006-01195 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 9901487 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 2006-01711 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 9501173 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: 200001476 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 900378 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 104318 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 39775 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 186647 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 172850 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5900571 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5905483 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NPB062 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NPB196 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE0108 . This is a "RAILROAD MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: NPB210 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89014R7 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NPB127 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 014R7 . This is a "BCBS GROUP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8000361 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NPB125 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NPB193 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5900489 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5904930 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5905687 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NPB126 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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