Provider Demographics
NPI:1588756944
Name:TALLAHASSEE PULMONARY CLINIC
Entity type:Organization
Organization Name:TALLAHASSEE PULMONARY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:E
Authorized Official - Last Name:STREETMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-878-8714
Mailing Address - Street 1:1401 CENTERVILLE RD
Mailing Address - Street 2:SUITE G02
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-878-8714
Mailing Address - Fax:850-878-2464
Practice Address - Street 1:1401 CENTERVILLE RD
Practice Address - Street 2:SUITE G02
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-878-8714
Practice Address - Fax:850-878-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063355100Medicaid
FL063355100Medicaid