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NPI Code Detail

MEDICARE: CRESTVIEW HOSPITAL COMPANY, LLC

MEDICARE: CRESTVIEW HOSPITAL COMPANY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1282N00000XGeneral Acute Care Hospital4298FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1426OTHERBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104897859
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRESTVIEW HOSPITAL COMPANY, LLC
Provider Business Mailing Address
First Line : PO BOX 198002
Second Line :
City : ATLANTA
State : GA
Zip : 30384-8002
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 151 E REDSTONE AVE
Second Line :
City : CRESTVIEW
State : FL
Zip : 32539-5352
Country : US
Telephone Number : 850-689-8100
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : PAULA LALOR
Credential :
Telephone Number : 629-215-3953
Provider Enumeration Date : 01/31/2006
Last Update Date : 03/22/2023

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Directions to “CRESTVIEW HOSPITAL COMPANY, LLC ” Practice Location

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