Healthcare Provider Details

I. General information

NPI: 1487440772
Provider Name (Legal Business Name): ROSS MEDICAL INTERNATIONAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 PARK TERRACE DR
SAINT AUGUSTINE FL
32080-5334
US

IV. Provider business mailing address

22 PARK TERRACE DR
SAINT AUGUSTINE FL
32080-5334
US

V. Phone/Fax

Practice location:
  • Phone: 904-347-8470
  • Fax: 904-368-5561
Mailing address:
  • Phone: 904-347-8470
  • Fax: 904-368-5561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH M ROSS
Title or Position: VICE PRESIDENT
Credential: DO, LM/CPM
Phone: 904-347-8470