SOUTH WALTON MEDICAL GROUP (NPI# 1457697278) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1457697278 |
Entity Type | Organization |
Organization Name | SOUTH WALTON MEDICAL GROUP |
Practice Address |
10065 Us Highway 98 W Ste B101 Miramar Beach FL 32550-1902 |
Practice Telephone | 8508378005 |
Practice Fax Number | 8508374352 |
Mailing Telephone | 8508378005 |
Mailing Fax Number | 8508374352 |
Enumeration Date | 2012-12-26 |
Last Update Date | 2013-06-17 |
Authorized Official Name | TERRANCE ROLAND REEVES (OWNER PHYSICIAN) |
Authorized Official Telephone | 8508378005 |
Authorized Official Credential | MD |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
FLME0067749 | FL | Allopathic & Osteopathic Physicians |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1063750610 | South Walton Medical Group | Clinic/Center | 10065 Us Highway 98 W, Suite B101, Miramar Beach, FL 32550-4924 | 2013-01-16 |
Street Address |
10065 US HIGHWAY 98 W STE B101 |
City | MIRAMAR BEACH |
State | FL |
Zip Code | 32550-1902 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1326652645 | S & R Dental Services, Inc. | Dentist | Carr. Int'l Zaragoza 445-1, Cd. Juarez, CHIHUAHUA 32550 | 2020-09-03 |
1801304746 | Dina Smith | Student in an Organized Health Care Education/Training Program | 12815 Highway 98, Suite 108, Miramar Beach, FL 32550 | 2018-01-12 |
1023484565 | The Hormone Restoration Center | Health Maintenance Organization | 12889 Hwy 98 W, Suite 107b, Miramar Beach, FL 32550 | 2015-08-19 |
1093051344 | Jason E Baker Dds LLC | Dentist | 77 South Shore Drive, Miramar Beach, FL 32550 | 2012-12-13 |
1801166210 | Yadhira A. Diaz | Dentist | Carr. Internacional Waterfill #500, Zaragoza, CHIHUAHUA 32550 | 2012-01-03 |
1427340355 | Asim S Ahmed | Internal Medicine | 7720 Us Highway 98 W Ste 110, Miramar Beach, FL 32550 | 2011-05-11 |
1922234160 | Ryan Winters | Physical Therapy Assistant | 7720 Highway 98, 220, Destin, FL 32550 | 2009-06-02 |
1619169133 | Jessica Marie Virtue | Specialist | 12815 Hwy 98 W, Suite 114, Destin, FL 32550 | 2007-08-17 |
1811100217 | Maria G Vazquez | Dentist | 445 Zaragoza, Juarez, MEXICO 32550 | 2007-05-08 |
1013137082 | Dental Waterfill Sc | Dentist | 445 Saborosa Ave, Sabarosa, CHIH 32550 | 2007-05-01 |
Find all providers in zip 32550 |
Taxonomy Code | 207QA0401X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Family Medicine |
Specialization | Addiction Medicine |
A family medicine physician who specializes in the diagnosis and treatment of addictions. |
Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
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1518441252 | Solstice Health and Wellness, LLC | Family Medicine | 1219 S East Ave South, Suite C204, Sarasota, FL 34239-2340 | 2018-09-19 |
1063956761 | Inspirations Recovery Center, LLC | Family Medicine | 5208 10th Ave N, Greenacres, FL 33463-2053 | 2016-12-14 |
1003365800 | Family First | Family Medicine | 5220 Hood Road, Suite 100, Palm Beach Gardens, FL 33418-8910 | 2016-09-22 |
1396290409 | Aquarius Physicians Group | Family Medicine | 749 Us Highway 1, Suite 210, North Palm Beach, FL 33408-4400 | 2016-08-18 |
1861823452 | Parthenon Behavioral Center | Family Medicine | 5101 Bowden Road, Jacksonville, FL 32216 | 2013-12-06 |
1851682066 | Jn Medical LLC | Family Medicine | 2625 West Way, Singer Island, FL 33404-3833 | 2011-04-21 |
Find all providers with the same taxonomy |
City | MIRAMAR BEACH |
Zip Code | 32550 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.