MEDICARE: HP MSO, 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	261QH0100X	Health Service Clinic/Center		FL

General Provider Information

NPI Number	:	1619457199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HP MSO, LLC

Provider Business Mailing Address
First Line	:	1090 JUPITER PARK DR FL 2
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-8939
Country	:	US
Telephone Number	:	561-745-3877
Fax Number	:

Provider Business Practice Location Address
First Line	:	1090 JUPITER PARK DR FL 2
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-8939
Country	:	US
Telephone Number	:	561-745-3877
Fax Number	:

Authorized Official
Title or Position	:	MGR MBR
Name	:	ROBERT CAMERLINCK
Credential	:
Telephone Number	:	561-371-4142

Provider Enumeration Date	:	08/15/2018
Last Update Date	:	08/15/2018

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