Healthcare Provider Details

I. General information

NPI: 1831428333
Provider Name (Legal Business Name): CAPITAL MEDICAL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1843 FIDDLER CT
TALLAHASSEE FL
32308-4450
US

IV. Provider business mailing address

1843 FIDDLER CT
TALLAHASSEE FL
32308-4450
US

V. Phone/Fax

Practice location:
  • Phone: 850-942-2463
  • Fax: 850-942-5666
Mailing address:
  • Phone: 850-942-2463
  • Fax: 850-942-5666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0051031
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME0051031
License Number StateFL

VIII. Authorized Official

Name: MR. JEFFREY L ARMSTRONG
Title or Position: OWNER
Credential: M.D.
Phone: 850-942-2463