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General NPI Number Information
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NPI Number | 1285683045
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Entity Type | Organization
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Legal Business Name | TALLAHASSEE MEMORIAL HEALTHCARE INC
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 15 COUNCIL MOORE RD
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City | CRAWFORDVILLE
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State | FL
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Zip | 32327-3117
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Country | US
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Telephone | 850-926-7105
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Fax | 850-926-2034
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Provider Business Mailing Address
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Address Line | 1607 SAINT JAMES CT STE 1
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5352
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Country | US
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Telephone | 850-431-7021
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Fax | 850-431-6975
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER PARKS
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Credential |
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Telephone | 850-431-6234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | FL
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