MEDICARE: FLORIDA INJURY & REGENERATIVE MEDICINE, PLLC

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	208D00000X	General Practice Physician
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1528680220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA INJURY & REGENERATIVE MEDICINE, PLLC

Provider Business Mailing Address
First Line	:	101 MARKETSIDE AVE # 404-777
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-1541
Country	:	US
Telephone Number	:	904-481-1111
Fax Number	:	832-442-3800

Provider Business Practice Location Address
First Line	:	3033 HARTLEY RD STE 6
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-6280
Country	:	US
Telephone Number	:	190-448-1111
Fax Number	:	832-442-3800

Authorized Official
Title or Position	:	MEMBER / AUTHORIZED REPRESENTATIVE
Name	:	DR. KIRT W REPP
Credential	:
Telephone Number	:	281-831-6290

Provider Enumeration Date	:	05/15/2020
Last Update Date	:	04/07/2026

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