MEDICARE: UZA32SC02

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207X00000X	Orthopaedic Surgery Physician
2	207XS0117X	Orthopaedic Surgery of the Spine Physician
3	208VP0014X	Interventional Pain Medicine Physician
4	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1588412175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UZA32SC02

Provider Business Mailing Address
First Line	:	4540 SOUTHSIDE BLVD STE 202
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5488
Country	:	US
Telephone Number	:	904-503-1065
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 SECOND BAXTER XING STE 108A
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6436
Country	:	US
Telephone Number	:	803-802-2225
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. SAMUEL CURTIS
Credential	:	DC
Telephone Number	:	803-800-4161

Provider Enumeration Date	:	05/08/2024
Last Update Date	:	05/08/2024

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