Provider Demographics
NPI:1215588306
Name:JMC TALLAHASSEE, LLC
Entity Type:Organization
Organization Name:JMC TALLAHASSEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOKSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-629-9100
Mailing Address - Street 1:2221 SW 19TH AVE RD STE #100
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471
Mailing Address - Country:US
Mailing Address - Phone:352-629-9100
Mailing Address - Fax:352-629-9200
Practice Address - Street 1:1838 JACLIFF COURT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-889-1234
Practice Address - Fax:850-273-6495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty