Seagrove Beach Medical Clinic Inc

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

License

PA3191 Issued in FL

Legal business name

SEAGROVE BEACH MEDICAL CLINIC INC

Practice address

5399 E County Highway 30a
Suite 5
Santa Rosa Beach, FL 32459-6717

Phone

(850) 231-6200

Fax

(850) 231-3500

NPI assigned

Feb 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. George Norman Roll, PA-C,MS,BA,BS,MPA

Title

Owner

Phone

(850) 231-6200

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387324800000",
    "number": "1710022827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5399 E COUNTY HIGHWAY 30A",
            "address_2": "SUITE 5",
            "city": "SANTA ROSA BEACH",
            "state": "FL",
            "postal_code": "324596717",
            "telephone_number": "850-231-6200",
            "fax_number": "850-231-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5399 E COUNTY HIGHWAY 30A",
            "address_2": "SUITE 5",
            "city": "SANTA ROSA BEACH",
            "state": "FL",
            "postal_code": "324596717",
            "telephone_number": "850-231-6200",
            "fax_number": "850-231-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEAGROVE BEACH MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2013-12-18",
        "status": "A",
        "authorized_official_last_name": "ROLL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "NORMAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-231-6200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C,MS,BA,BS,MPA"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "FL",
            "license": "PA3191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290446200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUS SHIELD",
            "identifier": "97275",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Urgent Care Clinic/Center in Santa Rosa Beach, FL
• Providers in Santa Rosa Beach, FL by specialty
• Urgent Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.