| Tanner Medical Enterprises, Inc | |
|
101 Florida Blvd Neptune Beach FL 32266-4966 | |
| (904) 241-2653 | |
| (904) 246-6312 |
| Full Name | Tanner Medical Enterprises, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 101 Florida Blvd, Neptune Beach, Florida |
| Authorized Official Name and Position | Millicent H Tanner (ADMINISTRATOR/OWNER) |
| Authorized Official Contact | 9042412653 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tanner Medical Enterprises, Inc Po Box 51595 Jacksonville Beach FL 32240-1595 Ph: (904) 241-2653 | Tanner Medical Enterprises, Inc 101 Florida Blvd Neptune Beach FL 32266-4966 Ph: (904) 241-2653 |
| NPI Number | 1508185190 |
|---|---|
| Provider Enumeration Date | 05/23/2010 |
| Last Update Date | 03/04/2013 |
| Medicare PECOS PAC ID | 8921253659 |
|---|---|
| Medicare Enrollment ID | O20130304000499 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508185190 | NPI | - | NPPES |
| 82622 | Other | FL | BCBS |
| 068895900 | Medicaid | FL |
| Provider Name | John C Tanner |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1952337990 PECOS PAC ID: 2668492596 Enrollment ID: I20051207000176 |
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