CRESTVIEW HOSPITAL CORPORATION NPI 1902854425

NPI Information

  • NPI: 1902854425
  • Provider Name: CRESTVIEW HOSPITAL CORPORATION
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Doing Business As: GATEWAY MEDICAL CLINIC DEFUNIAK
  • Address: 650 US HIGHWAY 331 S
    STE. 4
    DEFUNIAK SPRINGS, FL
    ZIP 32435
  • Phone: (850) 892-3366

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NPI Details

CRESTVIEW HOSPITAL CORPORATION is a family medicine in Defuniak Springs, 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 1902854425. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Gateway Medical Clinic Defuniak.

The provider's business location address is:

650 US HIGHWAY 331 S
STE. 4
DEFUNIAK SPRINGS, FL
ZIP 32435-349
Phone: (850) 892-3366

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 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
1207R00000XInternal MedicineNo
2261QR1300XClinic/CenterRural HealthNo
3207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1660058101MEDICAIDFLORIDA
240043AOTHERFLORIDABCBS OF FL

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

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

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