Healthcare Provider Details

I. General information

NPI: 1346349958
Provider Name (Legal Business Name): HOUSECALLS EXPRESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 SE INDIAN ST SUITE 112
STUART FL
34997-5675
US

IV. Provider business mailing address

1241 SE INDIAN ST SUITE 112
STUART FL
34997-5675
US

V. Phone/Fax

Practice location:
  • Phone: 772-781-2207
  • Fax: 772-781-2602
Mailing address:
  • Phone: 772-781-2207
  • Fax: 772-781-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND JEFFREY HULLEY
Title or Position: PRESIDENT
Credential: PA-C
Phone: 772-781-2207