MEDICARE: CHILDREN'S MEDICAL SERVICES TALLAHASSEE

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	251K00000X	Public Health or Welfare Agency

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

General Provider Information

NPI Number	:	1700845492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S MEDICAL SERVICES TALLAHASSEE

Provider Business Mailing Address
First Line	:	2390 PHILLIPS RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5326
Country	:	US
Telephone Number	:	850-487-2604
Fax Number	:	850-922-2123

Provider Business Practice Location Address
First Line	:	2390 PHILLIPS RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5326
Country	:	US
Telephone Number	:	850-487-2604
Fax Number	:	850-922-2123

Authorized Official
Title or Position	:	NURSING DIRECTOR
Name	:	MRS. KATHLEEN PITTMAN WILSON
Credential	:	D.S.N., A.R.N.P
Telephone Number	:	850-487-2604

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	08/22/2020

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Directions to “CHILDREN'S MEDICAL SERVICES TALLAHASSEE ” Practice Location

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