Organization
TALLAHASSEE EAR, NOSE & THROAT-HEAD & NECK SURGERY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM P. QUACKENBUSH C.R.M. (ADMINISTRATOR)
(850) 877-0101
Entity
Organization
Contact information
Practice address
1405 CENTERVILLE RD, SUITE 5400, TALLAHASSEE, FL 32308-4655
(850) 877-0101
(850) 877-2750
Mailing address
1405 CENTERVILLE ROAD, SUITE 5400, TALLAHASSEE, FL 32308-4629
(850) 877-0101
(850) 877-2750
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054317900
—
FL
01
—
33294
BCBS GROUP PROVIDER NUMBE
FL
Enumeration date
08/11/2006
Last updated
08/12/2011
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