MEDICARE: GENERAL SURGERY OF JUPITER MEDICAL SPECIALISTS, 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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1629742838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERAL SURGERY OF JUPITER MEDICAL SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	5565 CENTERVIEW DR STE 107
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-3563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 BURNS RD
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4604
Country	:	US
Telephone Number	:	877-328-1119
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KATHY KONDAS
Credential	:
Telephone Number	:	877-328-1119

Provider Enumeration Date	:	08/03/2021
Last Update Date	:	08/03/2021

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