Healthcare Provider Details

I. General information

NPI: 1922388875
Provider Name (Legal Business Name): TALLAHASSEE MEMORIAL HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 CENTENNIAL BLVD STE 100
TALLAHASSEE FL
32308
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 850-431-5404
  • Fax: 850-431-4794
Mailing address:
  • Phone: 850-431-7021
  • Fax: 850-431-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number4080
License Number StateFL

VIII. Authorized Official

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