Organization
SOUTHEASTERN UROLOGICAL CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RITA LEDLOW (BUSINESS OFFICE MANAGER)
(850) 309-0400
Entity
Organization
Contact information
Practice address
2000 CENTRE POINTE BLVD, TALLAHASSEE, FL 32308-4894
(850) 309-0400
(850) 309-0404
Mailing address
2000 CENTRE POINTE BLVD, TALLAHASSEE, FL 32308-4894
(850) 309-0400
(850) 309-0404
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10265
BCBS
FL
Enumeration date
06/04/2006
Last updated
04/13/2012
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