1366811077 NPI number — TALLAHASSEE MEMORIAL HEALTHCARE INC

Table of content: (NPI 1366811077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366811077 NPI number — TALLAHASSEE MEMORIAL HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TALLAHASSEE MEMORIAL HEALTHCARE 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:
TMH PHYSICIAN PARTNERS, CIM - ARCHIBALD
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:
1366811077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ARCHBOLD SPECIALTY CLINIC
Provider Second Line Business Mailing Address:
100 MIMOSA DRIVE
Provider Business Mailing Address City Name:
THOMASVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-228-2445
Provider Business Mailing Address Fax Number:
229-551-8775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 MEDICAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-216-0100
Provider Business Practice Location Address Fax Number:
850-216-0112
Provider Enumeration Date:
09/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MOSS
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
850-431-6256

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  4080 , 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)





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