SEAGROVE BEACH MEDICAL CLINIC INC (NPI# 1710022827) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710022827 |
| Entity Type | Organization |
| Organization Name | SEAGROVE BEACH MEDICAL CLINIC INC |
| Practice Address |
5399 E County Highway 30a Suite 5 Santa Rosa Beach FL 32459-6717 |
| Practice Telephone | 8502316200 |
| Practice Fax Number | 8502313500 |
| Mailing Telephone | 8502316200 |
| Mailing Fax Number | 8502313500 |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2013-12-18 |
| Authorized Official Name | MR. GEORGE NORMAN ROLL (OWNER) |
| Authorized Official Telephone | 8502316200 |
| Authorized Official Credential | PA-C,MS,BA,BS,MP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QU0200X |
Clinic/Center Specialization: Urgent Care |
PA3191 | FL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 290446200 | 05 | |
| FL | BLUE CROSS BLUS SHIELD | 97275 | 01 |
| Street Address |
5399 E COUNTY HIGHWAY 30A SUITE 5 |
| City | SANTA ROSA BEACH |
| State | FL |
| Zip Code | 32459-6717 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487761086 | Steven J Leikin | Dentist | 5399 E County Highway 30a, Suite 1, Santa Rosa Beach, FL 32459-6717 | 2006-08-23 |
| 1124510557 | Ross Jacob Ruder | Dentist | 5399 E County Highway 30a, Santa Rosa Beach, FL 32459-6717 | 2018-06-01 |
| 1366844854 | Seacrest Dental | Clinic/Center | 5399 E County Highway 30a, Santa Rosa Beach, FL 32459-6717 | 2014-09-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336740521 | Gary Mcfadyen | Hearing Instrument Specialist | 395 E. Point Washington, Santa Rosa Beach, FL 32459 | 2020-11-04 |
| 1235783218 | Camilla Ruth Chacon | Nurse Practitioner | 4821 Highway 98 West, Suite 104, Santa Rosa Beach, FL 32459 | 2019-07-29 |
| 1942797287 | Lauren Mank | Assistant Behavior Analyst | 67 Hiker St Fl 32459, Santa Rosa Beach, FL 32459 | 2018-04-20 |
| 1740781137 | Imaging Institute LLC | Radiology | 6757 Us Hwy 98 W Ste 301, Santa Rosa Beach, FL 32459 | 2018-02-22 |
| 1023540648 | Emerald Coast Medical Supplies LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 48 Bald Eagle Dr, Santa Rosa Beach, FL 32459 | 2017-04-02 |
| 1215485230 | Tamra Snook | Social Worker | 156 N County Highway 393 Unit 1, Santa Rosa Beach, FL 32459 | 2016-09-19 |
| 1437605730 | Alexandra Armstrong | Physical Therapist | 249 Mack Bayou Loop Ste 101, Santa Rosa Beach, FL 32459 | 2016-08-28 |
| 1386097749 | Itetra Smith | Behavior Technician | 67 Hiker St, Santa Rosa Beach, FL 32459 | 2016-07-20 |
| 1730527086 | Emerald Coast Medical Supplies LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 48 Bald Eagle Drive, Santa Rosa Beach, FL 32459 | 2013-06-10 |
| 1114269768 | Pamela Jean Skaff | Dentist | 101 Lecom Way, Defuniak Springs, FL 32459 | 2013-03-21 |
| Find all providers in zip 32459 | ||||
| Taxonomy Code | 261QU0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Urgent Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942611652 | Doc Smiley's Urgent Care LLC | Clinic/Center | 43 Cassine Way, Unit 102, Santa Rosa Beach, FL 32459-0456 | 2014-05-15 |
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|---|---|---|---|---|
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| 1689273187 | American Urgent Care and Walk In Clinics LLC | Clinic/Center | 601 Gray Ave, Wildwood, FL 34785-3520 | 2020-10-26 |
| 1619575529 | Medec Urgent Care Pllc | Clinic/Center | 600 Garden St, Titusville, FL 32796-3489 | 2020-10-13 |
| 1144835182 | Adventist Health System/sunbelt, Inc | Clinic/Center | 11826 State Road 54, Odessa, FL 33556-3496 | 2020-09-15 |
| 1528671096 | Crucialist LLC | Clinic/Center | 4230 Pablo Professional Ct Ste 103, Jacksonville, FL 32224-3223 | 2020-08-25 |
| 1194334961 | Md Now Medical Centers Inc | Clinic/Center | 4332 Cortez Rd W, Bradenton, FL 34210-3139 | 2020-07-28 |
| 1558970327 | Md Now Medical Centers Inc | Clinic/Center | 15165 Mcgregor Blvd, Fort Myers, FL 33908-1957 | 2020-07-28 |
| 1386253151 | Md Now Medical Centers Inc | Clinic/Center | 12748 S Cleveland Ave, Fort Myers, FL 33907-3823 | 2020-07-28 |
| 1821607698 | Md Now Medical Centers Inc | Clinic/Center | 2609 Santa Barbara Blvd, Cape Coral, FL 33914-4457 | 2020-07-28 |
| 1366051435 | Md Now Medical Centers Inc | Clinic/Center | 9690 Glades Rd Unit 425, Boca Raton, FL 33434-3978 | 2020-07-24 |
| Find all providers with the same taxonomy | ||||
| City | SANTA ROSA BEACH |
| Zip Code | 32459 |
Please comment or provide details below to improve the information on SEAGROVE BEACH MEDICAL CLINIC INC.
| 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.