Tallahassee Memorial Healthcare Inc
Organization Active NPI Rural Health Clinic/Center · Crawfordville, FL
NPI 1285683045 · NPPES record last updated Jan 9, 2025
Key facts
- NPI
- 1285683045
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- TALLAHASSEE MEMORIAL HEALTHCARE INC
- Practice address
- 15 Council Moore Rd
Crawfordville, FL 32327-3117 - Phone
- (850) 926-7105
- Fax
- (850) 926-2034
- NPI assigned
- May 9, 2006
- Organization subpart
- No
Authorized official
- Name
- Jennifer Parks
- Title
- President
- Phone
- (850) 431-6234
Owners & managing parties with NPI records 5
-
Frank Edward Gredler, M.D.
-
Thomas L Truman, MD
-
Dean D Watson, M.D.
-
Gary Winchester, M.D.
-
Andrew M Wong, MD
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 39
Other NPIs with the same Medicare PAC ID 10
Related certifications (CCN) 1
Practitioners 520
-
Kelly A Bane, PA-C, MPH
-
Karen M Bartley, MD
-
Callie Burch, DNP, APRN, FNP-BC
-
Bon M Clarke, APRN
-
Ashley C Duke, ARNP
-
Andrew Thomas Harrison, APRN
-
Jessica Hill, M.D.
-
Denna Hunter, FNP-BC
-
Cartier Patrick Lammert, ARNP
-
Joyce Catherine Lewis, PA-C
-
Braden J Shaffer, APN
-
John Michael Streacker, M.D.
-
Jennie Crews Strickland, ARNP
-
Kristin Stuchlik, APRN
-
Brittany Tenorio, ARNP-C
-
Travis Lee Wiggins, FNP-C
-
Julia Drude, CNM, FNP
-
Hilary H Lash, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL
Rural health clinic certification: CCN 103428
- Legal name
- TALLAHASSEE MEMORIAL HEALTHCARE INC
- Doing business as
- TMH PHYSICIAN PARNTERS, WAKULLA
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Sep 15, 1998
- Last certification
- Sep 28, 2023
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 29, 1979 in FL
- Enrollment address
- 15 Council Moore Rd
Crawfordville, FL 32327-3117 - Related CCNs
- 100135
All disclosed owners & managing parties 25
| Name | Role | Since | Share |
|---|---|---|---|
| Avery D McKnight |
Corporate Director |
Oct 1, 2012 | |
| Warren E Jones |
Corporate Officer |
Mar 8, 2004 | |
| W-2 Managing Employee |
Mar 8, 2004 | ||
| Jason Moore |
Corporate Officer |
Jul 7, 2008 | |
| W-2 Managing Employee |
Jul 7, 2008 | ||
| Glenda Thornton |
Corporate Director |
Oct 1, 2006 | |
| Paula S Fortunas |
Corporate Officer |
Jan 19, 2004 | |
| W-2 Managing Employee |
Jan 19, 2004 | ||
| Alma Littles |
Corporate Officer |
Oct 1, 2014 | |
| Corporate Director |
Oct 1, 2008 | ||
| Brant Copeland |
Corporate Director |
Oct 1, 2014 | |
| Donald W Lindsey |
Corporate Officer |
Mar 2, 2008 | |
| W-2 Managing Employee |
Mar 2, 2008 | ||
| Dean Watson |
Corporate Officer |
Jan 3, 2010 | |
| W-2 Managing Employee |
Jan 3, 2010 | ||
| Robert L Moore |
Corporate Officer |
Apr 14, 2013 | |
| W-2 Managing Employee |
Apr 14, 2013 | ||
| George M Obryant |
Corporate Officer |
Jul 14, 2003 | |
| W-2 Managing Employee |
Jul 14, 2003 | ||
| Andrew M Wong |
Corporate Director |
Oct 1, 2013 | |
| Cynthia Blair |
Corporate Officer |
May 23, 2005 | |
| W-2 Managing Employee |
May 23, 2005 | ||
| Jennifer Parks |
Corporate Director |
Dec 1, 2024 | |
| W-2 Managing Employee |
Dec 1, 2024 | ||
| Christopher S Rumana |
Corporate Director |
Oct 1, 2011 | |
| Susie Busch Transou |
Corporate Officer |
Oct 1, 2014 | |
| Corporate Director |
Oct 1, 2007 | ||
| Frank Gredler |
Corporate Officer |
Oct 1, 2014 | |
| Corporate Director |
Oct 1, 2006 | ||
| Lee Hinkle |
Corporate Director |
Oct 1, 2014 | |
| Rick Moore |
Corporate Director |
Oct 1, 2007 | |
| Martha W Barnett |
Corporate Director |
Oct 1, 2012 | |
| Thomas L Truman |
Corporate Director |
Oct 1, 2014 | |
| Steven L Evans |
Corporate Director |
Oct 1, 2012 | |
| Barbara E Alford |
Corporate Officer |
Mar 10, 2013 | |
| W-2 Managing Employee |
Mar 10, 2013 | ||
| Gary E Winchester |
Corporate Director |
Oct 1, 2011 | |
| Winston Howell |
Corporate Director |
Oct 1, 2013 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Tallahassee Memorial Behavior Health Center |
Hospital | Operational/Managerial Control (100%) | Jun 29, 1979 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031222000279 | FL | Part B Supplier - Clinic/Group Practice | 6103724778 |
Receives reassigned benefits from 702 practitioners 39 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tallahassee, FL; Blountstown, FL; Chipley, FL; Crawfordville, FL; Madison, FL; Marianna, FL; Monticello, FL; Panama City Beach, FL… |
| O20100310000505 | FL | Part a Provider - Rural Health Clinic | 6103724778 | Practice locations: Crawfordville, FL |
National Provider Directory
Locations
602 E 5th Ave
Havana, FL 32333
Phone (850) 539-4747
200 S Orange Ave
Ste 2900
Orlando, FL 32801
651 Grand Panama Blvd
Ste 101
Panama City Beach, FL 32407
21 N Love St
Quincy, FL 32351
Phone (850) 566-1639
1260 Metropolitan Blvd
Ste 301
Tallahassee, FL 32312
Phone (850) 201-4801
1549 Medical Dr
Tallahassee, FL 32308
1981 Capital Cir NE
#2
Tallahassee, FL 32308
410 W Tennessee St
#2
Tallahassee, FL 32301
1401 Centerville Rd
Ste 5000
Tallahassee, FL 32308
1309 Hodges Dr
Tallahassee, FL 32308
6721 Thomasville Rd
Ste 1
Tallahassee, FL 32312
Phone (850) 431-9000
1300 Miccosukee Rd
Ste 504
Tallahassee, FL 32308
1260 Metropolitan Blvd
Fl 3
Tallahassee, FL 32312
1305 E 6th Ave
Tallahassee, FL 32303
Phone 85043143325
1221 Hodges Dr
Tallahassee, FL 32308
6721 Thomasville Rd
Tallahassee, FL 32312
Phone (850) 893-8965
1304 Hodges Dr
#A
Tallahassee, FL 32308
Phone (850) 431-4500
1501 Surgeons Dr
Tallahassee, FL 32308
1260 Metropolitan Blvd
Ste 302
Tallahassee, FL 32312
Phone (859) 216-0100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | FL | Yes |
Addresses
Primary practice location
15 Council Moore Rd
Crawfordville, FL 32327-3117
Mailing address
1607 Saint James CT Ste 1
Tallahassee, FL 32308-5352
Phone (850) 431-7021
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 24766H | Other | FL | BCBS GROUP # |
| 375270406 | Medicaid | FL | |
| 660037903 | Medicaid | FL |
Other providers in Crawfordville, FL
- Libbie Stroud
- Landie Sufralien
- Shari D Sylvia
- T&a Lifted Living LLC
- Tallahassee Diagnostic Imaging LTD
- Tallahassee Memorial Healthcare Inc
- Tallahassee Orthopedic & Sports Physical Therapy
- Tallahassee Podiatry Associates PA
- Tara Nicole Williams LLC
- Renee Terrell
All providers in Crawfordville, FL · Rural Health Clinic/Center in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.