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General NPI Number Information
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NPI Number | 1427713130
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Entity Type | Organization
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Legal Business Name | NORTHWEST FLORIDA HEALTHCARE, INC.
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Dates
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Enumeration Date | 11/08/2021
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 3031 6TH ST
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City | MARIANNA
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State | FL
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Zip | 32446-1930
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Country | US
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Telephone | 850-482-4655
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Fax | 850-482-6694
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Provider Business Mailing Address
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Address Line | 1360 BRICKYARD RD
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City | CHIPLEY
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State | FL
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Zip | 32428-6303
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Country | US
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Telephone | 850-638-1610
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Fax | 850-638-0622
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | STEVEN LISENBY
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Credential |
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Telephone | 850-415-8107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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