MEDICARE: TALLAHASSEE MEMORIAL HEALTHCARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center
2	208800000X	Urology Physician	4080	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356868541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALLAHASSEE MEMORIAL HEALTHCARE INC

Provider Business Mailing Address
First Line	:	1607 SAINT JAMES CT STE 1
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5352
Country	:	US
Telephone Number	:	850-431-7021
Fax Number	:	850-431-6975

Provider Business Practice Location Address
First Line	:	2619 CENTENNIAL BLVD STE 102
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-0590
Country	:	US
Telephone Number	:	850-431-2875
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JENNIFER PARKS
Credential	:
Telephone Number	:	850-431-6234

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	01/09/2025

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Directions to “TALLAHASSEE MEMORIAL HEALTHCARE INC ” Practice Location

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