Provider Demographics
NPI:1114216165
Name:SANTA MONICA CENTERS
Entity Type:Organization
Organization Name:SANTA MONICA CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARTLEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-785-5652
Mailing Address - Street 1:36081 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1531
Mailing Address - Country:US
Mailing Address - Phone:727-785-5652
Mailing Address - Fax:
Practice Address - Street 1:36081 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1531
Practice Address - Country:US
Practice Address - Phone:727-785-5652
Practice Address - Fax:727-773-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty