MEDICARE: HP PRIMARY CARE, 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1740793504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HP PRIMARY CARE, LLC

Provider Business Mailing Address
First Line	:	1090 JUPITER PARK DR STE 200
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-8939
Country	:	US
Telephone Number	:	561-745-3877
Fax Number	:	561-745-3866

Provider Business Practice Location Address
First Line	:	1090 JUPITER PARK DR STE 200
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-8939
Country	:	US
Telephone Number	:	561-745-3877
Fax Number	:	561-745-3866

Authorized Official
Title or Position	:	CEO
Name	:	MR. ROBERT DOUGLAS CAMERLINCK
Credential	:
Telephone Number	:	561-371-4142

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	11/14/2017

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