Healthcare Provider Details

I. General information

NPI: 1013491596
Provider Name (Legal Business Name): INJURY AND REHAB CENTERS OF NORTH FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2268 WEDNESDAY STREET TALLAHASSEE
FLORIDA FL
32308
US

IV. Provider business mailing address

2268 WEDNESDAY STREET TALLAHASSEE
FLORIDA FL
32308
US

V. Phone/Fax

Practice location:
  • Phone: 850-765-6686
  • Fax: 850-329-6032
Mailing address:
  • Phone: 850-765-6686
  • Fax: 850-329-6032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM FREDERICK VON BARGEN JR.
Title or Position: AUTHORIZED MEMBER (AMBR)
Credential: DO
Phone: 850-765-6686