Healthcare Provider Details

I. General information

NPI: 1033791199
Provider Name (Legal Business Name): BIG BEND HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 MAHAN CENTER BLVD
TALLAHASSEE FL
32308-5428
US

IV. Provider business mailing address

1723 MAHAN CENTER BLVD
TALLAHASSEE FL
32308-5428
US

V. Phone/Fax

Practice location:
  • Phone: 702-960-2272
  • Fax:
Mailing address:
  • Phone: 702-960-2272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAM GIBSON
Title or Position: EXECUTIVE ASSISTANCE / BOARD LIAISO
Credential:
Phone: 850-878-5310