Provider Demographics
| NPI: | 1902886013 |
|---|---|
| Name: | HAMLET HMA PHYSICIAN MANAGEMENT, LLC |
| Entity type: | Organization |
| Organization Name: | HAMLET HMA PHYSICIAN MANAGEMENT, LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | SENIOR VICE PRESIDENT |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | STANLEY |
| Authorized Official - Middle Name: | D |
| Authorized Official - Last Name: | MCLEMORE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 239-598-3131 |
| Mailing Address - Street 1: | 5811 PELICAN BAY BLVD |
| Mailing Address - Street 2: | SUITE 500 |
| Mailing Address - City: | NAPLES |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 34108-2704 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 239-598-3131 |
| Mailing Address - Fax: | 239-598-9433 |
| Practice Address - Street 1: | 222 W MAIN ST |
| Practice Address - Street 2: | |
| Practice Address - City: | HAMLET |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 28345-3322 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 910-205-0400 |
| Practice Address - Fax: | 910-205-7796 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | HEALTH MANAGEMENT ASSOCIATES, INC. |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-01-17 |
| Last Update Date: | 2009-10-28 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| NC | 21758 | 207Q00000X |
| NC | 19375 | 207Q00000X |
| NC | 2006-01195 | 207RP1001X |
| NC | 9901487 | 207X00000X |
| NC | 2006-01711 | 208600000X |
| NC | 9501173 | 2086S0129X |
| NC | 200001476 | 208G00000X |
| NC | 900378 | 363LA2200X |
| NC | 104318 | 363LA2200X |
| NC | 39775 | 367500000X |
| NC | 186647 | 367500000X |
| NC | 172850 | 367500000X |
| NC | 32811 | 207R00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
| No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NC | 5900571 | Medicaid | |
| NC | 5905483 | Medicaid | |
| SC | NPB062 | Medicaid | |
| SC | NPB196 | Medicaid | |
| DE0108 | Other | RAILROAD MEDICARE GROUP | |
| SC | NPB210 | Medicaid | |
| NC | 89014R7 | Medicaid | |
| SC | NPB127 | Medicaid | |
| NC | 014R7 | Other | BCBS GROUP |
| NC | 8000361 | Medicaid | |
| SC | NPB125 | Medicaid | |
| SC | NPB193 | Medicaid | |
| NC | 5900489 | Medicaid | |
| NC | 5904930 | Medicaid | |
| NC | 5905687 | Medicaid | |
| SC | NPB126 | Medicaid | |
| NC | 5900571 | Medicaid |
