MEDICARE: WESTSIDE FAMILY MEDICAL CENTER PA

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	207Q00000X	Family Medicine Physician

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	:	1881761138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE FAMILY MEDICAL CENTER PA

Provider Business Mailing Address
First Line	:	1626 N PLAZA DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5323
Country	:	US
Telephone Number	:	850-513-0067
Fax Number	:	850-561-6670

Provider Business Practice Location Address
First Line	:	1626 N PLAZA DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5323
Country	:	US
Telephone Number	:	850-513-0067
Fax Number	:	850-561-6670

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JANET GIBSON
Credential	:	D.O.
Telephone Number	:	850-513-0067

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	02/07/2008

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Directions to “WESTSIDE FAMILY MEDICAL CENTER PA ” Practice Location

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