Healthcare Provider Details

I. General information

NPI: 1861441057
Provider Name (Legal Business Name): CRESTVIEW HOSPITAL COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E REDSTONE AVE
CRESTVIEW FL
32539-5352
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 850-689-8100
  • Fax:
Mailing address:
  • Phone: 615-628-6038
  • Fax: 615-628-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: KRISTINA MUSIC
Title or Position: DIR, ONBOARDING & PROV ENROLLMENT
Credential:
Phone: 877-892-9815