MEDICARE: FX SURGICAL 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	2084N0400X	Neurology Physician	OS7863	FL

General Provider Information

NPI Number	:	1497926166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FX SURGICAL LLC

Provider Business Mailing Address
First Line	:	10377 S US HIGHWAY 1
Second Line	:	SUITE 104
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5630
Country	:	US
Telephone Number	:	772-337-7272
Fax Number	:	772-337-7734

Provider Business Practice Location Address
First Line	:	10377 S US HIGHWAY 1
Second Line	:	SUITE 104
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5630
Country	:	US
Telephone Number	:	772-337-7272
Fax Number	:	772-337-7734

Authorized Official
Title or Position	:	CEO
Name	:	DR. FRANCIS X CONIDI
Credential	:	DO
Telephone Number	:	772-337-7272

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	03/20/2008

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