1356345862 NPI number — NORTH FLORIDA MEDICAL CENTERS, INC.

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 1356345862 NPI number — NORTH FLORIDA MEDICAL CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH FLORIDA MEDICAL CENTERS, INC.
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:
JESSIE FURLOW MEDICAL CENTER
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:
1356345862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2804 REMINGTON GREEN CIR STE 2
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:
32308-1550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-385-4494
Provider Business Mailing Address Fax Number:
850-298-6054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1249 STRONG ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-875-9500
Provider Business Practice Location Address Fax Number:
850-627-2786
Provider Enumeration Date:
06/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LUNN
Authorized Official First Name:
LANE
Authorized Official Middle Name:
MILLER
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
850-385-4494

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  00000 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 029568013 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 029568033 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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