Organization
SANTA ROSA HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
Santa Rosa HMA Physician Management LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
1121 BELLEVILLE AVE, BREWTON, AL 36426-1500
(251) 809-3230
(850) 626-5474
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
374819725
—
FL
Enumeration date
06/09/2021
Last updated
03/16/2022
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