MEDICARE: HEALTHMARK OF WALTON INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	4234	FL
2	251E00000X	Home Health Agency	212810961	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578544649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHMARK OF WALTON INC.

Provider Business Mailing Address
First Line	:	4413 US HIGHWAY 331 S
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32435-6307
Country	:	US
Telephone Number	:	850-951-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	4413 US HIGHWAY 331 S
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32435-6307
Country	:	US
Telephone Number	:	850-951-4500
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MS. LISA SHIRLEY HOLLEY
Credential	:	MS
Telephone Number	:	850-951-4508

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	09/13/2021

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