Healthcare Provider Details

I. General information

NPI: 1770647620
Provider Name (Legal Business Name): TALLAHASSEE MEMORIAL HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 HODGES DR
TALLAHASSEE FL
32308-4614
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 850-431-3456
  • Fax: 850-431-6403
Mailing address:
  • Phone: 850-431-7021
  • Fax: 850-431-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateFL

VIII. Authorized Official

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