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General NPI Number Information
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NPI Number | 1639904964
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Entity Type | Organization
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Legal Business Name | UPPERLINE HEALTHCARE, PC
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Dates
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Enumeration Date | 09/05/2024
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 1890 LPGA BLVD STE 250
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-7131
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Country | US
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Telephone | 386-339-4065
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Fax | 855-439-9682
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Provider Business Mailing Address
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Address Line | 4101 CHARLOTTE AVE STE F185
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City | NASHVILLE
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State | TN
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Zip | 37209-4066
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Country | US
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Telephone | 407-219-5402
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAVID VANDIVER THORPE
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Credential |
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Telephone | 205-807-3009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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