Organization
DOCTORS MEMORIAL HOSPITAL INC
Active
Other names
DMH Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAREN TIDWELL (CLINIC MANAGER)
(850) 223-5409
Entity
Organization
Contact information
Practice address
113 E MAIN ST, MAYO, FL 32066-4808
(386) 294-2475
(386) 294-2478
Mailing address
117 SW VIRGINIA CIR, MAYO, FL 32066-4065
(386) 294-2475
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
660123500
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D0961929
CLIA
—
01
—
24274C
BCBS
—
05
—
660123500
—
FL
Enumeration date
03/21/2006
Last updated
11/27/2012
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