NPIMap

Organization Active NPI

Tallahassee Ear, Nose & Throat-Head & Neck Surgery, P.a.

  • Otolaryngology Physician
  • Tallahassee, FL
National Provider Identifier
1790797728
Registry record updated Aug 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
TALLAHASSEE EAR, NOSE & THROAT-HEAD & NECK SURGERY, P.A.
Practice address
1405 Centerville Rd
Suite 5400
Tallahassee, FL 32308-4655
Phone
(850) 877-0101
Fax
(850) 877-2750
NPI assigned
Aug 11, 2006
Last updated
Aug 12, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2011

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

Authorized official

Name
Mrs. Kim P. Quackenbush, C.R.M.
Title
Administrator
Phone
(850) 877-0101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X Primary

Addresses

Primary practice location

1405 Centerville Rd
Suite 5400
Tallahassee, FL 32308-4655

Mailing address

1405 Centerville Road
Suite 5400
Tallahassee, FL 32308-4629
Phone (850) 877-0101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040602001104 FL Part B Supplier - Clinic/Group Practice 6608858840 Receives reassigned benefits from 16 practitioners
Practice locations: Tallahassee, FL

National Provider Directory

National Provider Directory

Locations

2625 Mitcham Dr
Tallahassee, FL 32308
Phone (850) 616-7011

114 W Hansell St
Thomasville, GA 31792
Phone (850) 877-0101

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313107200000",
    "number": "1790797728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 CENTERVILLE ROAD",
            "address_2": "SUITE 5400",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084629",
            "telephone_number": "850-877-0101",
            "fax_number": "850-877-2750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 CENTERVILLE RD",
            "address_2": "SUITE 5400",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084655",
            "telephone_number": "850-877-0101",
            "fax_number": "850-877-2750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAHASSEE EAR, NOSE & THROAT-HEAD & NECK SURGERY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2011-08-12",
        "status": "A",
        "authorized_official_last_name": "QUACKENBUSH",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "850-877-0101",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "C.R.M."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2011; 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.