Provider Demographics
NPI:1487869467
Name:NEIGHBORHOOD MEDICAL CENTER, INC
Entity type:Organization
Organization Name:NEIGHBORHOOD MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:850-459-2328
Mailing Address - Street 1:438 W BREVARD ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-1004
Mailing Address - Country:US
Mailing Address - Phone:850-224-2469
Mailing Address - Fax:850-224-1139
Practice Address - Street 1:438 W BREVARD ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-1004
Practice Address - Country:US
Practice Address - Phone:850-224-2469
Practice Address - Fax:850-513-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262263701Medicaid
FL112813300Medicaid
FL112813301Medicaid
FL262263702Medicaid
FL262263700Medicaid