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NPI Code Detail

MEDICARE: NEIGHBORHOOD MEDICAL CENTER, INC

MEDICARE: NEIGHBORHOOD MEDICAL CENTER, 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
11223G0001XGeneral Practice Dentistry
2261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851806079
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEIGHBORHOOD MEDICAL CENTER, INC
Provider Business Mailing Address
First Line : 438 W BREVARD ST
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32301-1004
Country : US
Telephone Number : 850-577-0045
Fax Number :
Provider Business Practice Location Address
First Line : 872 W ORANGE AVE
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32310-6123
Country : US
Telephone Number : 850-606-8226
Fax Number :
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : NELLIE R GRAHAM
Credential : MSCJ
Telephone Number : 850-577-0045
Provider Enumeration Date : 12/11/2017
Last Update Date : 03/28/2023

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Directions to “NEIGHBORHOOD MEDICAL CENTER, INC ” Practice Location

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