Organization
KETCHUM WOOD & BURGERT CHARTERED DRS KETCHUM WOOD & BURGERT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA FUQUA (ADMINISTRATOR)
(850) 219-7603
Entity
Organization
Contact information
Practice address
1899 EIDER CT, TALLAHASSEE, FL 32308-4537
(850) 878-5143
(850) 942-6622
Mailing address
1899 EIDER CT, TALLAHASSEE, FL 32308-4537
(850) 878-5143
(850) 942-6622
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
800000042
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030063201
—
FL
01
—
CF6643
RAILROAD MEDICARE
FL
01
—
L8014
BC/BS LAB SERVICES
FL
Enumeration date
02/14/2006
Last updated
05/15/2020
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