MEDICARE: HNC MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS5964	FL

General Provider Information

NPI Number	:	1407234099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HNC MEDICAL LLC

Provider Business Mailing Address
First Line	:	2423 S ORANGE AVE
Second Line	:	139
City	:	ORLANDO
State	:	FL
Zip	:	32806-4543
Country	:	US
Telephone Number	:	407-808-8763
Fax Number	:	407-978-6507

Provider Business Practice Location Address
First Line	:	13000 AVALON LAKE DR
Second Line	:	STE 100
City	:	ORLANDO
State	:	FL
Zip	:	32828-6434
Country	:	US
Telephone Number	:	407-808-8763
Fax Number	:	407-978-6507

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GEORGE HUDSON
Credential	:	D.O.
Telephone Number	:	407-808-8763

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	05/14/2015

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