Healthcare Provider Details

I. General information

NPI: 1134258726
Provider Name (Legal Business Name): TALLAHASSEE MEMORIAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 PHYSICIANS DR
TALLAHASSEE FL
32308-4619
US

IV. Provider business mailing address

1616 PHYSICIANS DR
TALLAHASSEE FL
32308-4619
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-5100
  • Fax:
Mailing address:
  • Phone: 850-431-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberSW5704
License Number StateFL

VIII. Authorized Official

Name: LAN MACDONALD
Title or Position: DIRECTOR OF OPERATIONS
Credential: R.N.
Phone: 850-431-5123