Tanner Medical Enterprises, Inc

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

OS4709 Issued in FL

Legal business name

TANNER MEDICAL ENTERPRISES, INC

Practice address

101 Florida Blvd
Neptune Beach, FL 32266-4966

Phone

(904) 241-2653

Fax

(904) 246-6312

NPI assigned

May 23, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Millicent H Tanner

Title

Administrator/Owner

Phone

(904) 241-2653

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Calvin Tanner, DO

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Jacksonville Beach, FL
  • NPI 1952337990

  Family Medicine

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1274572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362355200000",
    "number": "1508185190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51595",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322401595",
            "telephone_number": "904-241-2653",
            "fax_number": "904-246-6312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 FLORIDA BLVD",
            "city": "NEPTUNE BEACH",
            "state": "FL",
            "postal_code": "322664966",
            "telephone_number": "904-241-2653",
            "fax_number": "904-246-6312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TANNER MEDICAL ENTERPRISES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-23",
        "last_updated": "2013-03-04",
        "status": "A",
        "authorized_official_last_name": "TANNER",
        "authorized_official_first_name": "MILLICENT",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "ADMINISTRATOR/OWNER",
        "authorized_official_telephone_number": "904-241-2653"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS4709",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "FL",
            "license": "OS4709",
            "primary": true
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "FL",
            "license": "OS4709",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "82622",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "068895900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Addiction Medicine (Family Medicine) Physician in Neptune Beach, FL
• Providers in Neptune Beach, FL by specialty
• Addiction Medicine (Family Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.