Provider Demographics
NPI:1306269006
Name:FORT SMITH HMA PBC MANAGEMENT, LLC
Entity type:Organization
Organization Name:FORT SMITH HMA PBC MANAGEMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, HMPN
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-552-3575
Mailing Address - Street 1:PO BOX 402319
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2319
Mailing Address - Country:US
Mailing Address - Phone:479-573-7990
Mailing Address - Fax:479-573-7991
Practice Address - Street 1:4700 KELLEY HWY STE B
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72904-5024
Practice Address - Country:US
Practice Address - Phone:479-573-7990
Practice Address - Fax:479-573-7991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH MANAGEMENT ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty