Provider Demographics
NPI:1326587668
Name:MULTIDISCIPLINARY CENTER
Entity Type:Organization
Organization Name:MULTIDISCIPLINARY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSITANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:850-644-9920
Mailing Address - Street 1:715 W GAINES STREET
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:715 W GAINES STREET
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-644-9920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization