Basic Information
Provider Information | |||||||||
NPI: | 1164176483 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HPA MEDICAL MANAGEMENT, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3021 LORNA RD., SUITE 200 | ||||||||
Address2: |   | ||||||||
City: | BIRMINGHAM | ||||||||
State: | AL | ||||||||
PostalCode: | 35216 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2057256236 | ||||||||
FaxNumber: | 2053796720 | ||||||||
Practice Location | |||||||||
Address1: | 405 LAKE ZURICH RD | ||||||||
Address2: |   | ||||||||
City: | BARRINGTON | ||||||||
State: | IL | ||||||||
PostalCode: | 600103141 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8473815599 | ||||||||
FaxNumber: | 8473817552 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/06/2022 | ||||||||
LastUpdateDate: | 02/06/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ENGLISH | ||||||||
AuthorizedOfficialFirstName: | NORMA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | HOSPICE DIVISION PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 2055337216 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | RN | ||||||||
NPICertificationDate: | 02/06/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QH0002X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
No ID Information.