MEDICARE: INTEGRITY SPINE AND ORTHOPEDICS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363L00000X	Nurse Practitioner
2	363LA2200X	Adult Health Nurse Practitioner
3	208600000X	Surgery Physician
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	207X00000X	Orthopaedic Surgery Physician
6	207XS0117X	Orthopaedic Surgery of the Spine Physician

General Provider Information

NPI Number	:	1801457296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRITY SPINE AND ORTHOPEDICS LLC

Provider Business Mailing Address
First Line	:	14785 OLD SAINT AUGUSTINE RD STE 100
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-7407
Country	:	US
Telephone Number	:	904-456-0017
Fax Number	:	904-456-0018

Provider Business Practice Location Address
First Line	:	14785 OLD SAINT AUGUSTINE RD STE 100
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-7407
Country	:	US
Telephone Number	:	904-456-0017
Fax Number	:	904-456-0018

Authorized Official
Title or Position	:	PRESIDENT/COO
Name	:	MATTHEW TERRY
Credential	:
Telephone Number	:	904-456-0017

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	03/13/2025

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