Healthcare Provider Details

I. General information

NPI: 1811941834
Provider Name (Legal Business Name): TALLAHASSEE MEMORIAL HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 PHYSICIANS DR
TALLAHASSEE FL
32308-4619
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 850-431-5100
  • Fax: 850-431-6105
Mailing address:
  • Phone: 850-431-7021
  • Fax: 850-431-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4080
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4080
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4080
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4080
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4080
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4080
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number4080
License Number StateFL

VIII. Authorized Official

Name: MR. ROBIN L MOSS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 850-431-6256