Provider Demographics
NPI:1457470221
Name:TALLAHASSEE MEMORIAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:TALLAHASSEE MEMORIAL HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-431-5380
Mailing Address - Street 1:1300 MICCOSUKEE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5054
Mailing Address - Country:US
Mailing Address - Phone:850-431-5380
Mailing Address - Fax:850-431-5883
Practice Address - Street 1:1324 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6506
Practice Address - Country:US
Practice Address - Phone:850-431-6838
Practice Address - Fax:850-431-6826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty
No333300000XSuppliersEmergency Response System CompaniesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010113306Medicaid