Provider Demographics
NPI:1952687923
Name:COMMUNITY HEALTH OF TALLAHASSEE LLC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH OF TALLAHASSEE LLC
Other - Org Name:SURFSIDE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NOIRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MGR
Authorized Official - Phone:321-821-4889
Mailing Address - Street 1:325 5TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4273
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:325 5TH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4273
Practice Address - Country:US
Practice Address - Phone:321-674-9838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-22
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care