Provider Demographics
NPI:1083462188
Name:TALLAHASSEE ORTHOPEDIC CLINIC III, P.L.
Entity type:Organization
Organization Name:TALLAHASSEE ORTHOPEDIC CLINIC III, P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-219-1925
Mailing Address - Street 1:3334 CAPITAL MEDICAL BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4470
Mailing Address - Country:US
Mailing Address - Phone:850-877-8174
Mailing Address - Fax:
Practice Address - Street 1:7525 NW 4TH BLVD STE 90
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-1846
Practice Address - Country:US
Practice Address - Phone:352-744-7868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TALLAHASSEE ORTHOPEDIC CLINIC III, P.L.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier