Provider Demographics
NPI:1700821618
Name:SANTA ROSA ORTHOPEDIC ASSOC P A
Entity Type:Organization
Organization Name:SANTA ROSA ORTHOPEDIC ASSOC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHNEIDMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-623-0543
Mailing Address - Street 1:5750 BERRYHILL RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-8276
Mailing Address - Country:US
Mailing Address - Phone:850-623-0543
Mailing Address - Fax:850-623-5479
Practice Address - Street 1:5750 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-8276
Practice Address - Country:US
Practice Address - Phone:850-623-0543
Practice Address - Fax:850-623-5479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010147OtherBCBS ANTHEM
FLCH2250OtherRAILROAD MEDICARE
FL260384500Medicaid
AL5286015830OtherALACAID
FL52323OtherBCBS
AL59174845OtherBCBS
AL5286015830OtherALACAID
FL52323OtherBCBS