Healthcare Provider Details

I. General information

NPI: 1982922829
Provider Name (Legal Business Name): INTERNAL MEDICINE AND PEDIATRICS ASSOCIATESOF TALLAHASSEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2010
Last Update Date: 12/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 CAPITAL CIR NE SUITE 102
TALLAHASSEE FL
32308-8401
US

IV. Provider business mailing address

1965 CAPITAL CIR NE STE 200
TALLAHASSEE FL
32308-8402
US

V. Phone/Fax

Practice location:
  • Phone: 850-671-4600
  • Fax: 850-878-2863
Mailing address:
  • Phone: 850-656-2006
  • Fax: 850-656-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8447
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8447
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6702
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6702
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: YVETTE MIGNON
Title or Position: OWNER
Credential: MD
Phone: 850-656-2006