Organization · NPI-2
North Okaloosa Clinic Corp
Surgery · Crestview, FL
NPI number1023687993
StatusActive
Last updated in NPPESSep 22, 2023
Details
- NPI
- 1023687993
- Entity type
- Organization (NPI-2)
- Legal business name
- North Okaloosa Clinic Corp
- Organization subpart
- No
- Enumeration date
- Jun 23, 2021
- Certification date
- Sep 22, 2023
- Last updated
- Sep 22, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208600000X | Surgery | – | – | Yes |
Other names
- North Okaloosa Physician Group- Surgery Specialist (Doing Business As)
Practice location
550 Redstone Ave W Ste 410Crestview, FL 32536-6457
Phone 850-306-2188 · Fax 850-398-8470
Mailing address
Po Box 689022Franklin, TN 37068-9022
Phone 615-465-7211 · Fax 615-628-6877
Authorized official
Kristin Music
Dir Prov Enrollment & Onboarding
6154657377
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