MEDICARE: HELPING OPPRESSED & MARGINALIZED COMMUNITIES TO ELEVATE INC.

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1063144921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HELPING OPPRESSED & MARGINALIZED COMMUNITIES TO ELEVATE INC.

Provider Business Mailing Address
First Line	:	750 S ORANGE BLOSSOM TRL STE 156
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32805-3159
Country	:	US
Telephone Number	:	484-868-4948
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 S ORANGE BLOSSOM TRL STE 156
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32805-3159
Country	:	US
Telephone Number	:	484-868-4948
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PRESTON J QUEENAN
Credential	:
Telephone Number	:	484-868-4948

Provider Enumeration Date	:	06/29/2022
Last Update Date	:	07/11/2022

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