MEDICARE: TALLAHASSEE MEMORIAL HEALTHCARE INC

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	261QM1300X	Multi-Specialty Clinic/Center	4080	FL

General Provider Information

NPI Number	:	1184029704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALLAHASSEE MEMORIAL HEALTHCARE INC

Provider Business Mailing Address
First Line	:	1300 MEDICAL DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4646
Country	:	US
Telephone Number	:	850-216-0190
Fax Number	:	850-216-0112

Provider Business Practice Location Address
First Line	:	1260 METROPOLITAN BLVD
Second Line	:	SUITE 301
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-2557
Country	:	US
Telephone Number	:	850-201-4801
Fax Number	:	850-201-4802

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ROBIN L MOSS
Credential	:
Telephone Number	:	85043162561

Provider Enumeration Date	:	10/24/2014
Last Update Date	:	10/24/2014

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