Provider Demographics
NPI:1982660569
Name:TALLAHASSEE NEUROLOGICAL CLINIC
Entity Type:Organization
Organization Name:TALLAHASSEE NEUROLOGICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HULSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:850-558-1262
Mailing Address - Street 1:1401 CENTERVILLE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4675
Mailing Address - Country:US
Mailing Address - Phone:850-877-5115
Mailing Address - Fax:
Practice Address - Street 1:1401 CENTERVILLE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4675
Practice Address - Country:US
Practice Address - Phone:850-877-5115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053371801Medicaid
FL38233OtherGROUP BCBS NUMBER
FL053371800Medicaid
FL053371802Medicaid
FL053371802Medicaid
5968160001Medicare NSC