MEDICARE: TALLAHASSEE ORTHOPEDIC CLINIC III PL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QR0200X	Radiology Clinic/Center
2	335E00000X	Prosthetic/Orthotic Supplier
3	208VP0014X	Interventional Pain Medicine Physician
4	3336C0002X	Clinic Pharmacy
5	103G00000X	Clinical Neuropsychologist
6	261QP2000X	Physical Therapy Clinic/Center
7	261QM2500X	Medical Specialty Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	CG1216	OTHER	GA	RAILROAD MEDICARE #
8	CG3489	OTHER	GA	RAILROAD MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194778050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALLAHASSEE ORTHOPEDIC CLINIC III PL

Provider Business Mailing Address
First Line	:	3334 CAPITAL MEDICAL BLVD STE 400
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4470
Country	:	US
Telephone Number	:	850-877-8174
Fax Number	:	850-877-5636

Provider Business Practice Location Address
First Line	:	3334 CAPITAL MEDICAL BLVD STE 400
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4470
Country	:	US
Telephone Number	:	850-877-8174
Fax Number	:	844-261-6839

Authorized Official
Title or Position	:	DIRECTOR OF MANAGED CARE
Name	:	MELISSA BUTLER
Credential	:
Telephone Number	:	813-978-9700

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	02/17/2026

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