Healthcare Provider Details

I. General information

NPI: 1306369657
Provider Name (Legal Business Name): TALLAHASSEE MEMORIAL HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 NW CRANE AVE
MADISON FL
32340-1400
US

IV. Provider business mailing address

1300 MEDICAL DRIVE BILLING DEPARTMENT
TALLAHASSEE FL
32308-4622
US

V. Phone/Fax

Practice location:
  • Phone: 850-973-2271
  • Fax: 850-973-2818
Mailing address:
  • Phone: 850-216-0100
  • Fax: 850-216-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PARKS
Title or Position: PRESIDENT
Credential:
Phone: 850-431-6234