Provider Demographics
NPI:1144788332
Name:TALLAHASSEE ENHANCED CARE PA
Entity Type:Organization
Organization Name:TALLAHASSEE ENHANCED CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARINO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-354-8387
Mailing Address - Street 1:4012 KELCEY CT STE 203
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5986
Mailing Address - Country:US
Mailing Address - Phone:850-354-8387
Mailing Address - Fax:850-329-7878
Practice Address - Street 1:4012 KELCEY CT STE 203
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5986
Practice Address - Country:US
Practice Address - Phone:850-354-8387
Practice Address - Fax:850-329-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME110239OtherFL LICENSE