=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235665605
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TMH EMERGENCY PHYSICIAN GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2017
-----------------------------------------------------
Last Update Date | 05/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1260 METROPOLITAN BLVD
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32312-2536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-422-5413
-----------------------------------------------------
Fax | 850-422-5414
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 744237
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30374-4237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-422-5413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JENNIFER PARKS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 850-431-6234
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------