MEDICARE: HMG PRIMARY CARE PC

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	:	1174399422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HMG PRIMARY CARE PC

Provider Business Mailing Address
First Line	:	74785 US HIGHWAY 111 STE 101
Second Line	:
City	:	INDIAN WELLS
State	:	CA
Zip	:	92210-7129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	72650 FRED WARING DR STE 106
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-5007
Country	:	US
Telephone Number	:	760-230-9990
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN F FELLER
Credential	:	MD
Telephone Number	:	760-230-9990

Provider Enumeration Date	:	11/28/2023
Last Update Date	:	11/28/2023

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