Organization · NPI-2

Crestview Hospital Corporation

Family Medicine · Crestview, FL

NPI number1629026133
StatusActive
Last updated in NPPESMar 18, 2022

Details

NPI
1629026133
Entity type
Organization (NPI-2)
Legal business name
Crestview Hospital Corporation
Organization subpart
No
Enumeration date
May 5, 2006
Certification date
Feb 14, 2022
Last updated
Mar 18, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine––Yes
261QR1300X Clinic/Center, Rural Health––
207R00000X Internal Medicine––

Other names

  • Gateway Medical Clinic (Doing Business As)

Practice location

127c E. Redstone Ave
Crestview, FL 32539-5356

Phone 850-423-0061

Mailing address

330 Franklin Rd # 135a-316
Brentwood, TN 37027-3280

Phone 615-465-7000

Authorized official

Jennifer L Jackson
Sr Dir Onboarding & Prov Enrollment
6154653334

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