MEDICARE: NORTH WALTON RURAL HOSPITAL LLC

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	207P00000X	Emergency Medicine Physician
2	282NR1301X	Rural Acute Care Hospital

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750142121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH WALTON RURAL HOSPITAL LLC

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	:
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	:	850-920-2065
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HUY NGUYEN
Credential	:
Telephone Number	:	681-318-0790

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	03/03/2026

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