Healthcare Provider Details

I. General information

NPI: 1053146373
Provider Name (Legal Business Name): TALLAHASSEE ORTHOPEDIC CLINIC III, P.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2930 WELLINGTON CIR STE 101
TALLAHASSEE FL
32309-6878
US

IV. Provider business mailing address

3334 CAPITAL MEDICAL BLVD STE 400
TALLAHASSEE FL
32308-4470
US

V. Phone/Fax

Practice location:
  • Phone: 850-877-8174
  • Fax:
Mailing address:
  • Phone: 850-877-8174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ALLISON POWELL
Title or Position: MANAGED CARE COORDINATOR
Credential:
Phone: 850-219-1885