MEDICARE: HSP HOLDINGS, 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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1679316731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HSP HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	12717 CORALBERRY CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78732-2196
Country	:	US
Telephone Number	:	512-468-3810
Fax Number	:	866-847-8714

Provider Business Practice Location Address
First Line	:	12717 CORALBERRY CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78732-2196
Country	:	US
Telephone Number	:	512-468-3810
Fax Number	:	866-847-8714

Authorized Official
Title or Position	:	FOUNDER AND CEO
Name	:	HAWLEY S EVILSIZER
Credential	:	MS, RDN, LD
Telephone Number	:	512-468-3810

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	06/17/2024

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