Provider Demographics
NPI:1124408992
Name:PREMIER HEALTH CLINIC & REHABILITATION CENTER OF TALLAHASSEE
Entity type:Organization
Organization Name:PREMIER HEALTH CLINIC & REHABILITATION CENTER OF TALLAHASSEE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GHAZVINI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-942-6600
Mailing Address - Street 1:2820 REMINGTON GREEN CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-1547
Mailing Address - Country:US
Mailing Address - Phone:850-942-6600
Mailing Address - Fax:
Practice Address - Street 1:2820 REMINGTON GREEN CIR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-1547
Practice Address - Country:US
Practice Address - Phone:850-942-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74713261QR0400X
FLCH7212261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation