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	:	1679209803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPPERLINE HEALTHCARE PC

Provider Business Mailing Address
First Line	:	4101 CHARLOTTE AVE STE F185
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-4066
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 PONTE VEDRA PARK DR STE 150
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-6612
Country	:	US
Telephone Number	:	904-643-2124
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL KING
Credential	:
Telephone Number	:	615-627-2204

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	04/05/2023

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