| Tallahassee Memorial Healthcare Inc | |
|
2619 Centennial Blvd Ste 102 Tallahassee FL 32308-0590 | |
| (850) 431-2875 | |
| Not Available |
| Full Name | Tallahassee Memorial Healthcare Inc |
|---|---|
| Speciality | Urology |
| Location | 2619 Centennial Blvd Ste 102, Tallahassee, Florida |
| Authorized Official Name and Position | Jennifer Parks (PRESIDENT) |
| Authorized Official Contact | 8504316234 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tallahassee Memorial Healthcare Inc 1607 Saint James Ct Ste 1 Tallahassee FL 32308-5352 Ph: (850) 431-7021 | Tallahassee Memorial Healthcare Inc 2619 Centennial Blvd Ste 102 Tallahassee FL 32308-0590 Ph: (850) 431-2875 |
| NPI Number | 1356868541 |
|---|---|
| Provider Enumeration Date | 08/28/2017 |
| Last Update Date | 01/09/2025 |
| Medicare PECOS PAC ID | 6103724778 |
|---|---|
| Medicare Enrollment ID | O20171024003622 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356868541 | NPI | - | NPPES |
| 000000000 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 208800000X | Urology | 4080 (Florida) | Primary |
| Provider Name | Francisco Carpio |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1134219348 PECOS PAC ID: 2365425071 Enrollment ID: I20040617000806 |
| Provider Name | Charles W Yowell |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1447213467 PECOS PAC ID: 8729091228 Enrollment ID: I20060731000329 |
| Provider Name | Jonathan A Bussey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750758132 PECOS PAC ID: 1557679420 Enrollment ID: I20160711001131 |
| Provider Name | Sejal S Quayle |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1538156484 PECOS PAC ID: 5698798502 Enrollment ID: I20180523002218 |
| Provider Name | James Farrell |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1962713677 PECOS PAC ID: 9638300486 Enrollment ID: I20220120001893 |
| Provider Name | Anthony R Vara |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1093797482 PECOS PAC ID: 7416965082 Enrollment ID: I20220614003367 |
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