Provider Demographics
NPI:1447254958
Name:NORTH FLORIDA MEDICAL CENTERS INC
Entity type:Organization
Organization Name:NORTH FLORIDA MEDICAL CENTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LANE
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:LUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-385-4494
Mailing Address - Street 1:2804 REMINGTON GREEN CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-1550
Mailing Address - Country:US
Mailing Address - Phone:850-385-4494
Mailing Address - Fax:850-298-6054
Practice Address - Street 1:1328 COASTAL HWY
Practice Address - Street 2:
Practice Address - City:PANACEA
Practice Address - State:FL
Practice Address - Zip Code:32346-2151
Practice Address - Country:US
Practice Address - Phone:850-984-4735
Practice Address - Fax:850-984-4742
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH FLORIDA MEDICAL CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-13
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00000261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029568001Medicaid
FL029568021Medicaid
FL99388OtherMEDICARE PART B, GROUP PTAN
FL101846Medicare Oscar/Certification