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	261Q00000X	Clinic/Center	4080	FL

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

General Provider Information

NPI Number	:	1528410172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALLAHASSEE MEMORIAL HEALTHCARE INC

Provider Business Mailing Address
First Line	:	1607 SAINT JAMES CT STE 1
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5352
Country	:	US
Telephone Number	:	850-431-7021
Fax Number	:	850-431-6975

Provider Business Practice Location Address
First Line	:	6721 THOMASVILLE RD
Second Line	:	SUITE 4
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-4875
Country	:	US
Telephone Number	:	850-431-9000
Fax Number	:	850-431-9001

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ROBIN L MOSS
Credential	:
Telephone Number	:	850-431-6256

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	01/28/2019

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