30A Medical Incorporated
Organization Active NPI Family Medicine Physician · Santa Rosa Beach, FL
NPI 1851762991 · NPPES record last updated Jun 30, 2017
Key facts
- NPI
- 1851762991
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- 30A MEDICAL INCORPORATED
- Practice address
- 4164 W County Highway 30a
Santa Rosa Beach, FL 32459-4336 - Phone
- (850) 622-2313
- Fax
- (850) 622-2718
- NPI assigned
- Oct 15, 2015
- Organization subpart
- No
Authorized official
- Name
- Mr. Scott Thurston, DC
- Title
- Owner
- Phone
- (850) 622-2313
Practitioners 6
-
Thomas Michael John, M. D.
-
Bryce Amos, APRN
-
Amanda Sharp, PA-C
-
Michael J Ceranowski, PA-C, CAA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160111000473 | FL | Part B Supplier - Clinic/Group Practice | 0648572560 |
Receives reassigned benefits from 2 practitioners Practice locations: Santa Rosa Beach, FL |
National Provider Directory
Locations
4164 W County Highway 30A
Santa Rsa Bch, FL 32459
Phone (850) 622-2313
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
4164 W County Highway 30a
Santa Rosa Beach, FL 32459-4336
Mailing address
4164 W County Highway 30a
Santa Rosa Beach, FL 32459-4336
Phone (850) 622-2313
Other providers in Santa Rosa Beach, FL
- 1162 Military Trail LLC
- 30-A Therapy Inc
- 30A Dental Solutions, P.a.
- 30A Sleep Solutions, P.a.
- Aaip LLC
- Annette Abel
- Jennifer P Aboud
- Advanced Behavioral Analysis, LLC
All providers in Santa Rosa Beach, FL · Family Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.