1558553982 NPI number — TALLAHASSEE ORTHOPEDIC CLINIC III PL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558553982 NPI number — TALLAHASSEE ORTHOPEDIC CLINIC III PL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TALLAHASSEE ORTHOPEDIC CLINIC III PL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TALLAHASSEE ORTHOPEDIC CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558553982
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3334 CAPITAL MEDICAL BLVD STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32308-4470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-877-8174
Provider Business Mailing Address Fax Number:
844-261-6839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 WHEAT AVE STE 800
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAINBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39819-4367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-246-3608
Provider Business Practice Location Address Fax Number:
229-246-1635
Provider Enumeration Date:
08/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
LORI
Authorized Official Middle Name:
J
Authorized Official Title or Position:
BUSINESS OFFICE DIRECTOR
Authorized Official Telephone Number:
850-219-1925

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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