Provider Demographics
NPI:1447029384
Name:RST ADVANCEMENT FLORIDA LLC
Entity type:Organization
Organization Name:RST ADVANCEMENT FLORIDA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:912-270-5676
Mailing Address - Street 1:1015 ARTHUR J MOORE DR
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-2206
Mailing Address - Country:US
Mailing Address - Phone:904-719-7404
Mailing Address - Fax:904-719-7405
Practice Address - Street 1:1015 ARTHUR J MOORE DR
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-2206
Practice Address - Country:US
Practice Address - Phone:904-719-7404
Practice Address - Fax:904-719-7405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty