MEDICARE: SEVEN BRIDGES PAIN SPECIALISTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	363A00000X	Physician Assistant
3	363LF0000X	Family Nurse Practitioner
4	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1225743404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEVEN BRIDGES PAIN SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	2023 MYRA ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3714
Country	:	US
Telephone Number	:	904-503-5464
Fax Number	:	904-575-4399

Provider Business Practice Location Address
First Line	:	2023 MYRA ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3714
Country	:	US
Telephone Number	:	904-503-5464
Fax Number	:	904-575-4399

Authorized Official
Title or Position	:	OWNER
Name	:	RENEE GALLO
Credential	:	MD
Telephone Number	:	904-503-5464

Provider Enumeration Date	:	01/20/2023
Last Update Date	:	09/11/2023

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