Provider Demographics
NPI:1528015302
Name:HMA SANTA ROSA MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:HMA SANTA ROSA MEDICAL CENTER LLC
Other - Org Name:SANTA ROSA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:6002 BERRYHILL RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-5062
Mailing Address - Country:US
Mailing Address - Phone:850-626-7762
Mailing Address - Fax:850-623-5083
Practice Address - Street 1:6002 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-5062
Practice Address - Country:US
Practice Address - Phone:850-623-7762
Practice Address - Fax:850-623-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4342282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010174500Medicaid
FL424OtherBLUE CROSS
FL424OtherBLUE CROSS