MEDICARE: NORTH FLORIDA MEDICAL CENTERS 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	261QF0400X	Federally Qualified Health Center (FQHC)	00000	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	:	1598769192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH FLORIDA MEDICAL CENTERS INC

Provider Business Mailing Address
First Line	:	2804 REMINGTON GREEN CIR STE 2
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-1550
Country	:	US
Telephone Number	:	850-385-4494
Fax Number	:	850-298-6054

Provider Business Practice Location Address
First Line	:	255 W RIVER RD
Second Line	:
City	:	WEWAHITCHKA
State	:	FL
Zip	:	32465-4533
Country	:	US
Telephone Number	:	850-639-5828
Fax Number	:	850-639-5536

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	LANE MILLER LUNN
Credential	:
Telephone Number	:	850-385-4494

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	12/10/2020

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