Provider Demographics
NPI:1013044262
Name:SANTA ROSA COUNTY HEALTH DEPARTMENT - PRIMARY CARE
Entity Type:Organization
Organization Name:SANTA ROSA COUNTY HEALTH DEPARTMENT - PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEVORE JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MSPH
Authorized Official - Phone:850-983-5200
Mailing Address - Street 1:PO BOX 929
Mailing Address - Street 2:5527 STEWART ST
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32572-0929
Mailing Address - Country:US
Mailing Address - Phone:850-983-5200
Mailing Address - Fax:850-983-4816
Practice Address - Street 1:5527 STEWART ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4303
Practice Address - Country:US
Practice Address - Phone:850-983-5200
Practice Address - Fax:850-983-4816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02796760Medicaid
FL02796760Medicaid