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DSH100135V TALLAHASSEE MEMORIAL HEALTHCARE, INC (Active)
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Main Details
Name
TALLAHASSEE MEMORIAL HEALTHCARE, INC
Subdivision Name
TMHPP SMG Cardiothoracic Surgery - Cardiothoracic Surgery
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100135V
Medicare Provider Number
100135
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/13/2020
Participating Start Date
1/1/2021
Participating Approval Date
10/19/2020
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
1405 Centerville Road
Suite 5000
Tallahassee, FL 32308
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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