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NPI Code Detail

MEDICARE: TALLAHASSEE COVID TESTING, LLC

MEDICARE: TALLAHASSEE COVID TESTING, LLC
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
1247ZC0005XClinical Laboratory Director (Non-physician)

General Provider Information

NPI Number : 1861006983
Entity Type Code : Organization
Provider Name (Legal Business Name) : TALLAHASSEE COVID TESTING, LLC
Provider Business Mailing Address
First Line : 220 OFFICE PLZ
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32301-2808
Country : US
Telephone Number : 850-694-8169
Fax Number :
Provider Business Practice Location Address
First Line : 220 OFFICE PLZ
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32301-2808
Country : US
Telephone Number : 850-694-8169
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : SURINA ALVARADO
Credential :
Telephone Number : 850-694-8169
Provider Enumeration Date : 09/04/2020
Last Update Date : 09/12/2020

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