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	:	1932856150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPPERLINE HEALTHCARE, PC

Provider Business Mailing Address
First Line	:	102 WOODMONT BLVD STE 450
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-5202
Country	:	US
Telephone Number	:	407-219-5402
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	:	DAVID VANDIVER THORPE
Credential	:
Telephone Number	:	205-807-3009

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	03/08/2022

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