Organization

Cross Creek Medical Pa

Internal Medicine Physician in Tallahassee, FL(View on Map)

Legal Business Name

Cross Creek Medical Pa

NPI Number

1447438486

NPI Type

Organization

Enumeration Date

02/01/2008

Specialties

(Taxonomies)

Code

207R00000X

Primary Taxonomy

Yes

Licenses

State

Florida

License Number

0071014FLME

Contact
Information

Purpose

Mailing
Location

Address

1381A CROSS CREEK CIR
1381 CROSS CREEK CIR

City

Tallahassee
Tallahassee

State

FL
FL

Postal Code

32301-3729
32301-3723

Country

US
US

Telephone Number

(850) 877-6393
(850) 877-6393

Authorized Official

Name

Dr. Wayne Sampson

Title or Position

MEDICAL DIRECTOR

Telephone Number

(850) 877-6393

Identifiers

Identifier

250984900
DF9814
003457000

Identifier State

FL
FL
FL

Identifier Issuer

Unknown
RAILROAD MEDICARE
Unknown

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 10/05/2011

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