Provider Demographics
NPI:1518968551
Name:CAPITAL REGIONAL HEALTHCARE
Entity Type:Organization
Organization Name:CAPITAL REGIONAL HEALTHCARE
Other - Org Name:MEDICAL GROUP OF NORTH FLORIDA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-878-8235
Mailing Address - Street 1:2626 CARE DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-878-8235
Mailing Address - Fax:850-219-2395
Practice Address - Street 1:2626 CARE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-878-8235
Practice Address - Fax:850-219-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1851212163W00000X
FLARNP1125292163W00000X
FLARNP1737562163W00000X
FLARNP1947622163W00000X
FLARNP579352163W00000X
FLME21311207Q00000X
FLME88971207QA0505X
FLME56839207R00000X
FLME42103207R00000X
FLME59307207R00000X
FLME26991207R00000X
FLME83075207RC0000X
FLME69965207RG0100X
FLOS6976208D00000X
FLPO2824213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058464900Medicaid
FLCK0297OtherRAILROAD MEDICARE
FL99039Medicare ID - Type UnspecifiedGROUP NUMBER