Basic Information
| Provider Information | |||||||||
| NPI: | 1215588306 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JMC TALLAHASSEE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2221 SW 19TH AVE RD STE #100 | ||||||||
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| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526299100 | ||||||||
| FaxNumber: | 3526299200 | ||||||||
| Practice Location | |||||||||
| Address1: | 1838 JACLIFF COURT | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508891234 | ||||||||
| FaxNumber: | 8502736495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2019 | ||||||||
| LastUpdateDate: | 09/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | CHOKSI | ||||||||
| AuthorizedOfficialFirstName: | SAMER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT / OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3526299100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0500X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine |
No ID Information.