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General NPI Number Information
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NPI Number | 1336120187
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Entity Type | Organization
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Legal Business Name | OKALOOSA HOSPITAL, INC
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 2190 HIGHWAY 85 N
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City | NICEVILLE
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State | FL
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Zip | 32578-1045
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Country | US
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Telephone | 850-729-9407
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Fax | 850-729-9418
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Provider Business Mailing Address
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Address Line | 2190 HIGHWAY 85 N
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City | NICEVILLE
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State | FL
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Zip | 32578-1045
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Country | US
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Telephone | 850-729-9407
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Fax | 850-729-9418
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Authorized Official
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Title or Position | CFO
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Name | MARK DAY
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Credential |
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Telephone | 850-729-9302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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