Healthcare Provider Details

I. General information

NPI: 1750142121
Provider Name (Legal Business Name): NORTH WALTON RURAL HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4413 US HIGHWAY 331 S
DEFUNIAK SPRINGS FL
32435-6307
US

IV. Provider business mailing address

4413 US HIGHWAY 331 S
DEFUNIAK SPRINGS FL
32435-6307
US

V. Phone/Fax

Practice location:
  • Phone: 850-920-2065
  • Fax:
Mailing address:
  • Phone: 850-920-2065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: JON WARD
Title or Position: OWNER
Credential: MD
Phone: 850-290-2065