Provider Demographics
NPI:1851806079
Name:NEIGHBORHOOD MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:NEIGHBORHOOD MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NELLIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MSCJ
Authorized Official - Phone:850-577-0045
Mailing Address - Street 1:438 W BREVARD ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-1004
Mailing Address - Country:US
Mailing Address - Phone:850-577-0045
Mailing Address - Fax:
Practice Address - Street 1:872 W ORANGE AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32310-6123
Practice Address - Country:US
Practice Address - Phone:850-606-8226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1487869467
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-11
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112813702Medicaid
FL112812300Medicaid
FL112863500Medicaid