Organization
SEAGROVE BEACH MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEORGE NORMAN ROLL PA-C,MS,BA,BS,MPA (OWNER)
(850) 231-6200
Entity
Organization
Contact information
Practice address
5399 E COUNTY HIGHWAY 30A, SUITE 5, SANTA ROSA BEACH, FL 32459-6717
(850) 231-6200
(850) 231-3500
Mailing address
5399 E COUNTY HIGHWAY 30A, SUITE 5, SANTA ROSA BEACH, FL 32459-6717
(850) 231-6200
(850) 231-3500
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
PA3191
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290446200
—
FL
01
—
97275
BLUE CROSS BLUS SHIELD
FL
Enumeration date
02/20/2007
Last updated
12/18/2013
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