MEDICARE: NORTH FLORIDA MEDICAL CENTER

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	261QD0000X	Dental Clinic/Center
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1700120425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH FLORIDA MEDICAL CENTER

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	:	301 HUGHES ST NE
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32548-6403
Country	:	US
Telephone Number	:	850-423-4603
Fax Number	:

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

Provider Enumeration Date	:	11/19/2012
Last Update Date	:	12/10/2020

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Directions to “NORTH FLORIDA MEDICAL CENTER ” Practice Location

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