Provider Demographics
NPI:1558310391
Name:TALLAHASSEE MEMORIAL HEALTHCARE INC
Entity Type:Organization
Organization Name:TALLAHASSEE MEMORIAL HEALTHCARE INC
Other - Org Name:TMHPP CENTER FOR MATERNAL FETAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-431-6256
Mailing Address - Street 1:1607 SAINT JAMES CT STE 1
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5352
Mailing Address - Country:US
Mailing Address - Phone:850-431-7021
Mailing Address - Fax:850-431-6975
Practice Address - Street 1:1401 CENTERVILLE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4647
Practice Address - Country:US
Practice Address - Phone:850-431-3360
Practice Address - Fax:850-431-3370
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TALLAHASSEE MEMORIAL HEALTHCARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-09
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375270411Medicaid
FL24766FOtherBCBS GROUP #
FL24766FMedicare ID - Type UnspecifiedMEDICARE GROUP #