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Michele L. Musto

Hospitalist

Allopathic & Osteopathic Physicians

820 Prudential Dr Ste 304, Jacksonville, FL 32207-8205

PECOS Enrollment

This provider is enrolled in PECOS as MICHELE MUSTO.

Based on the most recent information from CMS, provider Michele L. Musto is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:21 AM.

Profile Details

Provider ID
1699977694
Provider Type
Individual
Full Name
Musto, Michele L.
Title
Dr.
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
6/1/2007
Last Updated
1/25/2019

Contact Information

Practice Location

820 Prudential Dr Ste 304, Jacksonville, FL 32207-8205

(904) 202-3860

(904) 202-3846

Mailing Location

PO Box 45443, Salt Lake City, UT 84145-0443

(904) 202-1032

(904) 376-4107

Provider Taxonomies

Code	Description	License
Code 208M00000X Primary	Description Hospitalist Allopathic & Osteopathic Physicians	License ME112784 Florida
Code 207Q00000X	Description Family Medicine Allopathic & Osteopathic Physicians	License 000556 Georgia
Code 207QA0505X	Description Family Medicine Allopathic & Osteopathic Physicians	License TL31424 South Carolina
Code 207QA0505X	Description Family Medicine Allopathic & Osteopathic Physicians	License 112784 Florida
Code 207QA0505X	Description Family Medicine Allopathic & Osteopathic Physicians	License 180956 North Carolina

Provider Identifiers

ID	Description	Issuer
ID 013879800	Description Medicaid	Issuer Unlisted Florida
ID 770574093A	Description Medicaid	Issuer Unlisted Georgia
ID 01067717	Description Other	Issuer AMERIGROUP MEDICAID Georgia
ID 395491	Description Other	Issuer WELLCARE MEDICAID Georgia

Michele L. Musto

PECOS Enrollment

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