Provider Demographics
NPI:1700845492
Name:CHILDREN'S MEDICAL SERVICES TALLAHASSEE
Entity Type:Organization
Organization Name:CHILDREN'S MEDICAL SERVICES TALLAHASSEE
Other - Org Name:FLORIDA DEPARTMENT OF HEALTH - CHILDREN'S MEDICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:PITTMAN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DSN, ARNP
Authorized Official - Phone:850-487-2604
Mailing Address - Street 1:2390 PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5326
Mailing Address - Country:US
Mailing Address - Phone:850-487-2604
Mailing Address - Fax:850-922-2123
Practice Address - Street 1:2390 PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5326
Practice Address - Country:US
Practice Address - Phone:850-487-2604
Practice Address - Fax:850-922-2123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare