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General NPI Number Information
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NPI Number | 1609490895
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Entity Type | Organization
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Legal Business Name | SEGUE HEALTH OF FLORIDA LLC
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 113 S MONROE ST FL 1
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City | TALLAHASSEE
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State | FL
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Zip | 32301-1529
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Country | US
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Telephone | 888-551-2538
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Fax | 844-364-2629
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Provider Business Mailing Address
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Address Line | 765 WOODLAND TRACE LN
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City | CORDOVA
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State | TN
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Zip | 38018-6609
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Country | US
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Telephone | 901-626-3515
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Fax | 844-364-2629
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Authorized Official
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Title or Position | SECRETARY
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Name | CAMILLE CLARK
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Credential |
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Telephone | 901-626-3515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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