1497617948 NPI number — TALLAHASSEE ORTHOPEDIC CLINIC III, P.L.

Table of content: MRS. MEISSA DAVIS BROCK LCAS (NPI 1730401597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497617948 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:
Provider Other Organization Name Type Code:
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:
1497617948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5901 E FOWLER AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPLE TERRACE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33617-2305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-978-9700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 N ARNOLD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PANAMA CITY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32413-2523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-978-9700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2025

Additional Information

Authorized Official

Authorized Official Last Name:
CHARI
Authorized Official First Name:
RAVI
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
615-579-2733

Provider Taxonomy Codes

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

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





Copyright © 2007-2025 www.npivalidator.com