1366294365 NPI number — TALLAHASSEE ORTHOPEDIC CLINIC III, P.L.

Table of content: (NPI 1366294365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366294365 NPI number — TALLAHASSEE ORTHOPEDIC CLINIC III, P.L.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TALLAHASSEE ORTHOPEDIC CLINIC III, P.L.
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:
1366294365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2024
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:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7525 NW 4TH BLVD STE 90
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32607-1846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-647-9700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2024

Additional Information

Authorized Official

Authorized Official Last Name:
POWELL
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
850-877-8174

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com