Organization
NEIGHBORHOOD MEDICAL CENTER, INC
Active
Parent organization
1487869467
Organization subpart
Yes
Provider details
NPI number
Legal business name
1487869467
Authorized official
NELLIE R GRAHAM MSCJ (CREDENTIALING MANAGER)
(850) 577-0045
Entity
Organization
Contact information
Practice address
872 W ORANGE AVE, TALLAHASSEE, FL 32310-6123
(850) 606-8226
Mailing address
438 W BREVARD ST, TALLAHASSEE, FL 32301-1004
(850) 577-0045
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112812300
—
FL
05
—
112813702
—
FL
05
—
112863500
—
FL
Enumeration date
12/11/2017
Last updated
03/28/2023
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