Healthcare Provider Details

I. General information

NPI: 1811953128
Provider Name (Legal Business Name): TALLAHASSEE MEMORIAL HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 LASALLE LEFALL DR
QUINCY FL
32351-5278
US

IV. Provider business mailing address

1607 SAINT JAMES CT STE 1
TALLAHASSEE FL
32308-5352
US

V. Phone/Fax

Practice location:
  • Phone: 850-875-3600
  • Fax: 850-627-7277
Mailing address:
  • Phone: 850-431-7021
  • Fax: 850-431-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBIN L MOSS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 850-431-7021