| Santa Rosa Hma Physician Management Llc | |
|
4225 Woodbine Rd Ste A Pace FL 32571-8791 | |
| (850) 994-6575 | |
| (850) 994-5643 |
| Full Name | Santa Rosa Hma Physician Management Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4225 Woodbine Rd Ste A, Pace, Florida |
| Authorized Official Name and Position | Jennifer L Jackson (SR DIR PROV ENROLLMENT & ONBOARDING) |
| Authorized Official Contact | 6154653334 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Santa Rosa Hma Physician Management Llc Po Box 689022 Franklin TN 37068-9022 Ph: (615) 465-7211 | Santa Rosa Hma Physician Management Llc 4225 Woodbine Rd Ste A Pace FL 32571-8791 Ph: (850) 994-6575 |
| NPI Number | 1043880347 |
|---|---|
| Provider Enumeration Date | 06/29/2021 |
| Last Update Date | 03/16/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043880347 | NPI | - | NPPES |
| 374819701 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207X00000X | Orthopaedic Surgery | (* (Not Available)) | Secondary |
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