Healthcare Provider Details

I. General information

NPI: 1083390470
Provider Name (Legal Business Name): TALLAHASSEE ORTHOPEDIC CLINIC III PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 CARLISLE RD
CHIPLEY FL
32428-4360
US

IV. Provider business mailing address

3334 CAPITAL MEDICAL BLVD STE 400
TALLAHASSEE FL
32308-4470
US

V. Phone/Fax

Practice location:
  • Phone: 850-526-3236
  • Fax: 844-261-6844
Mailing address:
  • Phone: 850-877-8174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ALLISON POWELL
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 850-219-1885