MEDICARE: INJURY INSTITUTE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2081P0004X	Spinal Cord Injury Medicine Physician
2	2081P0301X	Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
3	208100000X	Physical Medicine & Rehabilitation 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	:	1821533316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INJURY INSTITUTE LLC

Provider Business Mailing Address
First Line	:	793 SANDPIPER LN
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-2726
Country	:	US
Telephone Number	:	904-425-9044
Fax Number	:	904-425-9094

Provider Business Practice Location Address
First Line	:	944 ARLINGTON RD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5956
Country	:	US
Telephone Number	:	904-425-9044
Fax Number	:	904-425-9094

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK ANTHONY LIVECCHI
Credential	:	M.D.
Telephone Number	:	585-750-5348

Provider Enumeration Date	:	12/20/2016
Last Update Date	:	12/20/2016

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Directions to “INJURY INSTITUTE LLC ” Practice Location

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