Provider Demographics
NPI:1770940009
Name:MHC2 OF TALLAHASSEE
Entity type:Organization
Organization Name:MHC2 OF TALLAHASSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:850-559-3402
Mailing Address - Street 1:209 OFFICE PLZ
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2807
Mailing Address - Country:US
Mailing Address - Phone:850-877-0199
Mailing Address - Fax:
Practice Address - Street 1:209 OFFICE PLZ
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2807
Practice Address - Country:US
Practice Address - Phone:850-877-0199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty