Provider Demographics
NPI:1902854219
Name:TALLAHASSEE CARDIOLOGY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:TALLAHASSEE CARDIOLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CRUTCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-656-7265
Mailing Address - Street 1:2631 CENTENNIAL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-0588
Mailing Address - Country:US
Mailing Address - Phone:850-656-7265
Mailing Address - Fax:850-702-0245
Practice Address - Street 1:2631 CENTENNIAL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0588
Practice Address - Country:US
Practice Address - Phone:850-656-7265
Practice Address - Fax:850-702-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43879, ME72196174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00827100Medicaid
FLF89443OtherBACHTEL UPIN
FL252361200OtherBACHTEL MD MEDICAID
FL1902809932OtherBAKER MD NPI
FL000827100OtherDIXON MD MEDCAID
FLDE9596OtherRR MEDICARE
FL276041000Medicaid
FL1205839222OtherBACHTEL NPI
FLCO2333OtherBAKER UPIN
FL1669534897OtherDIXON MD NPI 1669534897
FL72230OtherBCBS GROUP
FLFLO69118600OtherBAKER MEDICAID
FLDE9596OtherRR MEDICARE
FL00827100Medicaid