| Saint George Medical Center Inc | |
|
1118 Hospital Rd Fort Walton Beach FL 32547-6742 | |
| (850) 862-3415 | |
| Not Available |
| Full Name | Saint George Medical Center Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1118 Hospital Rd, Fort Walton Beach, Florida |
| Authorized Official Name and Position | Erica George-saintilus (OWNER) |
| Authorized Official Contact | 8508623415 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Saint George Medical Center Inc 790 Barley Port Ln Fort Walton Beach FL 32547-5722 Ph: (850) 862-3415 | Saint George Medical Center Inc 1118 Hospital Rd Fort Walton Beach FL 32547-6742 Ph: (850) 862-3415 |
| NPI Number | 1184137929 |
|---|---|
| Provider Enumeration Date | 11/15/2017 |
| Last Update Date | 06/16/2018 |
| Medicare PECOS PAC ID | 5294097994 |
|---|---|
| Medicare Enrollment ID | O20180316000574 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184137929 | NPI | - | NPPES |
| 190605 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | ME100869 (Florida) | Primary |
| Provider Name | Erica Adona George-saintilus |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679771281 PECOS PAC ID: 5496829475 Enrollment ID: I20080808000668 |
| Provider Name | Rattanavalee Jansod Havlat |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124761093 PECOS PAC ID: 3476927401 Enrollment ID: I20230314003108 |
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