Organization
CAPITAL REGIONAL MEDICAL GROUP
Active
Parent organization
CAPITAL REGIONAL MEDICAL CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
CAPITAL REGIONAL MEDICAL CENTER
Authorized official
DR. RICHARD THACKER D.O. (PHYSICIAN)
(850) 878-8235
Entity
Organization
Contact information
Practice address
2770 CAPITAL MEDICAL BLVD, SUITE 200, TALLAHASSEE, FL 32308-8417
(850) 878-8235
Mailing address
363 MILESTONE DR, TALLAHASSEE, FL 32312-3575
(954) 445-7760
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
ARNP9188795
FL
Other
Enumeration date
11/06/2014
Last updated
11/06/2014
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