ROCK STAR REP INC NPI 1871734541

NPI Information

  • NPI: 1871734541
  • Provider Name: ROCK STAR REP INC
  • Classification: Clinic/Center - 261Q00000X
  • Entity Type: Organization
  • Doing Business As: SOUTH WALTON MEDICAL
  • CLIA Number: 10D1102027
  • Address: 10065 US HIGHWAY 98 W
    STE B 101
    MIRAMAR BEACH, FL
    ZIP 32550
  • Phone: (850) 837-8005

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NPI Details

ROCK STAR REP INC is a clinic center in Miramar Beach, FL. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). ROCK STAR REP INC NPI is 1871734541. The provider is registered as an organization entity type.
The provider Is Doing Business As South Walton Medical.

The provider's business location address is:

10065 US HIGHWAY 98 W
STE B 101
MIRAMAR BEACH, FL
ZIP 32550-924
Phone: (850) 837-8005
Fax: (850) 837-4352

The provider's authorized official is Perry Monty Reeves .
The authorized official title is Ceo and has the following contact phone number (863) 513-0349.

The CLIA number assigned to this NPI record is 10D1102027 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/10/2009 and was last updated on 4/9/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/CenterYes

What is NPI?

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This page was last updated on: 11/21/2025

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