MEDICARE: FORT PIERCE ORTHOPAEDICS 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	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528720331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT PIERCE ORTHOPAEDICS LLC

Provider Business Mailing Address
First Line	:	2000 HEALTH PARK DR
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4692
Country	:	US
Telephone Number	:	615-372-5426
Fax Number	:

Provider Business Practice Location Address
First Line	:	3683 S MIAMI AVE STE 500
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-4238
Country	:	US
Telephone Number	:	305-285-5025
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	WILLIAM TEDRICK JOHNSON
Credential	:
Telephone Number	:	615-372-3375

Provider Enumeration Date	:	10/08/2021
Last Update Date	:	10/08/2021

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