Provider Demographics
NPI:1619757952
Name:SANTA ROSA HB MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:SANTA ROSA HB MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR HOSPITAL BASED PROGRAM
Authorized Official - Prefix:
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:
Authorized Official - Last Name:KEETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-628-6507
Mailing Address - Street 1:PO BOX 680060
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-0060
Mailing Address - Country:US
Mailing Address - Phone:615-628-6504
Mailing Address - Fax:659-235-6176
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:850-626-7762
Practice Address - Fax:659-235-6176
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANTA ROSA HB MEDICAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-04
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty