| Squareone Aesthetics And Wellness | |
|
857 E Park Ave Tallahassee FL 32301-2620 | |
| (850) 765-9923 | |
| (904) 339-9322 |
| Full Name | Squareone Aesthetics And Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 857 E Park Ave, Tallahassee, Florida |
| Authorized Official Name and Position | Timothy Woodfin Walker (PRESIDENT) |
| Authorized Official Contact | 8509046767 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Squareone Aesthetics And Wellness 857 E Park Ave Tallahassee FL 32301-2620 Ph: (850) 765-9923 | Squareone Aesthetics And Wellness 857 E Park Ave Tallahassee FL 32301-2620 Ph: (850) 765-9923 |
| NPI Number | 1285311431 |
|---|---|
| Provider Enumeration Date | 06/29/2023 |
| Last Update Date | 10/22/2023 |
| Medicare PECOS PAC ID | 6507212594 |
|---|---|
| Medicare Enrollment ID | O20231027000335 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285311431 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Timothy Walker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679525463 PECOS PAC ID: 8729042361 Enrollment ID: I20041115000358 |
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