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: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 E LAFAYETTE ST
TALLAHASSEE FL
32301-4569
US

IV. Provider business mailing address

2228 CAPITAL CIR NE
TALLAHASSEE FL
32308-4306
US

V. Phone/Fax

Practice location:
  • Phone: 850-765-6686
  • Fax: 877-450-4723
Mailing address:
  • Phone: 850-765-6686
  • Fax: 877-450-4723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
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