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1861441057

NPI Code Detail

MEDICARE: CRESTVIEW HOSPITAL COMPANY LLC

MEDICARE: CRESTVIEW HOSPITAL COMPANY 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	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician
3	208M00000X	Hospitalist Physician		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
2	34833	OTHER	FL	BCBS
3	40043	OTHER	FL	BCBS
4	40043A	OTHER	FL	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861441057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRESTVIEW HOSPITAL COMPANY LLC

Provider Business Mailing Address
First Line	:	PO BOX 689022
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-9022
Country	:	US
Telephone Number	:	615-628-6038
Fax Number	:	615-628-6832

Provider Business Practice Location Address
First Line	:	151 E REDSTONE AVE
Second Line	:
City	:	CRESTVIEW
State	:	FL
Zip	:	32539-5352
Country	:	US
Telephone Number	:	850-689-8100
Fax Number	:

Authorized Official
Title or Position	:	DIR, ONBOARDING & PROV ENROLLMENT
Name	:	KRISTINA MUSIC
Credential	:
Telephone Number	:	877-892-9815

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	11/09/2023

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Directions to “CRESTVIEW HOSPITAL COMPANY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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