Provider Demographics
NPI:1851365019
Name:TALLAHASSEE PEDIATRIC FOUNDATION, INC.
Entity Type:Organization
Organization Name:TALLAHASSEE PEDIATRIC FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/NURSING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:850-488-7935
Mailing Address - Street 1:1126 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6508
Mailing Address - Country:US
Mailing Address - Phone:850-488-7935
Mailing Address - Fax:850-488-0918
Practice Address - Street 1:1126 LEE AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6508
Practice Address - Country:US
Practice Address - Phone:850-488-7935
Practice Address - Fax:850-488-0918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care