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General NPI Number Information
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NPI Number | 1821665621
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Entity Type | Organization
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Legal Business Name | SANTA ROSA HMA PHYSICIAN MANAGEMENT LLC
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 1121 BELLEVILLE AVE
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City | BREWTON
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State | AL
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Zip | 36426-1500
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Country | US
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Telephone | 251-809-3230
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Fax | 850-626-5474
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Provider Business Mailing Address
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Address Line | PO BOX 689022
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City | FRANKLIN
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State | TN
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Zip | 37068-9022
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Country | US
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Telephone | 615-465-7211
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Fax | 615-628-6877
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Authorized Official
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Title or Position | SR DIR PROV ENROLLMENT & ONBOARDING
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Name | JENNIFER L JACKSON
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Credential |
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Telephone | 615-465-3334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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