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General NPI Number Information
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NPI Number | 1629918347
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Entity Type | Organization
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Legal Business Name | FORT WALTON BEACH MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 200 TEQUESTA DR
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City | DESTIN
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State | FL
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Zip | 32541-4758
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Country | US
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Telephone | 850-837-9194
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Fax |
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Provider Business Mailing Address
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Address Line | 200 TEQUESTA DR
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City | DESTIN
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State | FL
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Zip | 32541-4758
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Country | US
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Telephone | 850-837-9194
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KENNETH DONAHEY II
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Credential |
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Telephone | 850-862-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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