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General NPI Number Information
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NPI Number | 1851806079
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Entity Type | Organization
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Legal Business Name | NEIGHBORHOOD MEDICAL CENTER, INC
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 872 W ORANGE AVE
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City | TALLAHASSEE
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State | FL
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Zip | 32310-6123
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Country | US
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Telephone | 850-606-8226
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Fax |
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Provider Business Mailing Address
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Address Line | 438 W BREVARD ST
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City | TALLAHASSEE
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State | FL
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Zip | 32301-1004
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Country | US
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Telephone | 850-577-0045
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | NELLIE R GRAHAM
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Credential | MSCJ
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Telephone | 850-577-0045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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