Healthcare Provider Details

I. General information

NPI: 1982920906
Provider Name (Legal Business Name): NORTH FLORIDA MEDICAL CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOSPITAL DR
CRESTVIEW FL
32539-7385
US

IV. Provider business mailing address

2804 REMINGTON GREEN CIR STE 2
TALLAHASSEE FL
32308-1550
US

V. Phone/Fax

Practice location:
  • Phone: 850-423-4603
  • Fax: 850-423-0473
Mailing address:
  • Phone: 850-385-4494
  • Fax: 850-298-6054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: LANE MILLER LUNN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 850-385-4494