Provider Demographics
NPI:1609490895
Name:SEGUE HEALTH OF FLORIDA LLC
Entity Type:Organization
Organization Name:SEGUE HEALTH OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-626-3515
Mailing Address - Street 1:765 WOODLAND TRACE LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6609
Mailing Address - Country:US
Mailing Address - Phone:901-626-3515
Mailing Address - Fax:844-364-2629
Practice Address - Street 1:113 S MONROE ST FL 1
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-1529
Practice Address - Country:US
Practice Address - Phone:888-551-2538
Practice Address - Fax:844-364-2629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty