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DSH100135B TALLAHASSEE MEMORIAL HEALTHCARE, INC (Active)
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Main Details
Name
TALLAHASSEE MEMORIAL HEALTHCARE, INC
Subdivision Name
Tallahassee Memorial Physician Partners Southwood-Medical Specialists
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100135B
Medicare Provider Number
100135
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2014
Participating Start Date
4/1/2014
Participating Approval Date
2/18/2014
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Tallahassee Memorial HealthCare
Priscilla Needham, Chief Financial Officer
(850) 431-0630
Primary Contact
Tallahassee Memorial HealthCare
Louis Kynard, Director of Pharmacy
(850) 431-5030
Addresses
Street Address
3900 Esplanade Way
Tallahassee, FL 32311
Billing Address
Tallahassee Memorial HealthCare, Inc
1300 Miccosukee Road
Tallahassee, FL 32308
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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