MEDICARE: UPPERLINE HEALTHCARE, PC

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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1306456751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPPERLINE HEALTHCARE, PC

Provider Business Mailing Address
First Line	:	102 WOODMONT BLVD STE 450
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-5202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 FLORIDA PARK DR N
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-3866
Country	:	US
Telephone Number	:	386-445-4734
Fax Number	:	386-445-8411

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID VANDIVER THORPE
Credential	:
Telephone Number	:	205-807-3009

Provider Enumeration Date	:	07/31/2020
Last Update Date	:	02/02/2021

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