CRESTVIEW HOSPITAL CORPORATION NPI 1629026133

NPI Information

  • NPI: 1629026133
  • Provider Name: CRESTVIEW HOSPITAL CORPORATION
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Doing Business As: GATEWAY MEDICAL CLINIC
  • CLIA Number: 10D0898737
  • Address: 127C E. REDSTONE AVE
    CRESTVIEW, FL
    ZIP 32539
  • Phone: (850) 423-0061

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NPI Details

CRESTVIEW HOSPITAL CORPORATION is a family medicine in Crestview, FL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. CRESTVIEW HOSPITAL CORPORATION NPI is 1629026133. The provider is registered as an organization entity type.
The provider Is Doing Business As Gateway Medical Clinic.

The provider's business location address is:

127C E. REDSTONE AVE
CRESTVIEW, FL
ZIP 32539-356
Phone: (850) 423-0061

The provider's authorized official is Jennifer L Jackson .
The authorized official title is Sr Dir Onboarding & Prov Enrollment and has the following contact phone number (615) 465-3334.

The CLIA number assigned to this NPI record is 10D0898737 - rural health clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/5/2006 and was last updated on 3/18/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QR1300XClinic/CenterRural HealthNo
2207R00000XInternal MedicineNo
3207Q00000XFamily MedicineYes

What is NPI?

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This page was last updated on: 11/21/2025

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