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General NPI Number Information
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NPI Number | 1629026133
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Entity Type | Organization
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Legal Business Name | CRESTVIEW HOSPITAL CORPORATION
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 127C E. REDSTONE AVE
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City | CRESTVIEW
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State | FL
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Zip | 32539-5356
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Country | US
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Telephone | 850-423-0061
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Fax |
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Provider Business Mailing Address
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Address Line | 330 FRANKLIN RD # 135A-316
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City | BRENTWOOD
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State | TN
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Zip | 37027-3280
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Country | US
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Telephone | 615-465-7000
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Fax |
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Authorized Official
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Title or Position | SR DIR ONBOARDING & PROV ENROLLMENT
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Name | JENNIFER L JACKSON
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Credential |
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Telephone | 615-465-3334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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