Basic Information
| Provider Information | |||||||||
| NPI: | 1710323571 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TALLAHASSEE MEMORIAL HEALTHCARE INC | ||||||||
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| OtherOrganizationName: | TALLAHASSEE MEMORIAL EMERGENCY CENTER - NORTHEAST | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1607 SAINT JAMES CT STE 1 | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504317021 | ||||||||
| FaxNumber: | 8504316975 | ||||||||
| Practice Location | |||||||||
| Address1: | 1260 METROPOLITAN BLVD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323122557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504225413 | ||||||||
| FaxNumber: | 8504225414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2013 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | MOSS | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8504316256 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | 4080 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
No ID Information.