Wade G Douglas, MD
Individual provider Active NPI Surgery Physician · Tallahassee, FL
NPI 1689634388 · NPPES record last updated Aug 19, 2014
Key facts
- NPI
- 1689634388
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- ME120744 (FL)
- Practice address
- 1401 Centerville Road
Suite 100
Tallahassee, FL 32308-3656 - Phone
- (850) 877-5183
- Fax
- (850) 656-1288
- NPI assigned
- Mar 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141008001552 | FL | Practitioner - General Surgery |
6507896172 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Doctors Memorial Hospital Inc | Current |
Accepting new patients | |
| Tallahassee Memorial Healthcare Inc | Current | Accepting new patients | |
| Madison County Hospital Health Systems, Inc. | Current |
Accepting new patients | |
| Tallahassee Memorial Healthcare Inc | Current | Accepting new patients | |
| Doctors Memorial Hospital Inc | Surgery | Current | Accepting new patients |
| Doctors Memorial Hospital Inc | Current |
Accepting new patients | |
| Madison County Hospital Health Systems, Inc. | Current |
Accepting new patients | |
| Doctors Memorial Hospital Inc | Past | Accepting new patients | |
| Hospital Authority of the City of Bainbridge and Decatur County | Past | Accepting new patients | |
| Doctors Memorial Hospital Inc | Past | Accepting new patients |
Locations
224 NW Crane Ave
Madison, FL 32340
Phone (850) 253-1923
555 N Byron Butler Pkwy
Perry, FL 32347
Phone (850) 431-5360
333 N Byron Butler Pkwy
Perry, FL 32347
Phone (850) 584-0643
333 N Byron Butler Pkwy
Fl Second
Perry, FL 32347
1607 Saint James Ct
Ste 1
Tallahassee, FL 32308
Phone (850) 431-7021
1300 Miccosukee Rd
Tallahassee, FL 32308
Phone (850) 431-1155
Interoperability endpoints
- wdouglas21589@tallahasseememorial.direct-ci.com
- wade.douglas.1@5867.direct.athenahealth.com
- wadedouglas@tmhpp.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 21963 | WV | |
| Surgery Physician | 208600000X | ME120744 | FL | Yes |
| Surgical Oncology Physician | 2086X0206X | 21963 | WV |
Addresses
Primary practice location
1401 Centerville Road
Suite 100
Tallahassee, FL 32308-3656
Mailing address
1401 Centerville Road
Suite 100
Tallahassee, FL 32308-3656
Phone (850) 877-5183
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64102411 | Medicaid | KY | |
| 2586732 | Medicaid | OH | |
| 3810002707 | Medicaid | WV |
Other providers in Tallahassee, FL
- Andrea Nichole Doss
- Jason Doss
- Michael Dottorelli
- Cynthia P Douglas
- Tanya Douglas
- Michael L Douso
- Michael Anthony Dow
- Jessica Shadae Dowd
- Chandra Yvonne Dowdell
- Angela L Dowdy
All providers in Tallahassee, FL · Surgery Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2014. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.