MEDICARE: PORT CHARLOTTE HBP SERVICES 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	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376147835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT CHARLOTTE HBP SERVICES LLC

Provider Business Mailing Address
First Line	:	4000 MERIDIAN BLVD
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6325
Country	:	US
Telephone Number	:	615-465-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2521 DEL PRADO BLVD N
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-4003
Country	:	US
Telephone Number	:	941-766-4122
Fax Number	:	941-766-4140

Authorized Official
Title or Position	:	DIRECTOR, PROVIDER SERVICES
Name	:	MS. KRISTINA MUSIC
Credential	:
Telephone Number	:	877-892-9815

Provider Enumeration Date	:	11/25/2020
Last Update Date	:	11/09/2023

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