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General NPI Number Information
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NPI Number | 1851762991
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Entity Type | Organization
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Legal Business Name | 30A MEDICAL INCORPORATED
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 06/30/2017
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Provider Practice Location Address
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Address Line | 4164 W COUNTY HIGHWAY 30A
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-4336
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Country | US
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Telephone | 850-622-2313
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Fax | 850-622-2718
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Provider Business Mailing Address
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Address Line | 4164 W COUNTY HIGHWAY 30A
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-4336
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Country | US
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Telephone | 850-622-2313
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Fax | 850-622-2718
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Authorized Official
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Title or Position | OWNER
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Name | MR. SCOTT THURSTON
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Credential | DC
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Telephone | 850-622-2313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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