Provider Demographics
NPI:1588171789
Name:NORTHWEST FLORIDA HEALTHCARE, INC.
Entity type:Organization
Organization Name:NORTHWEST FLORIDA HEALTHCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARCEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-415-8127
Mailing Address - Street 1:1360 BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-6303
Mailing Address - Country:US
Mailing Address - Phone:850-638-1610
Mailing Address - Fax:850-638-0622
Practice Address - Street 1:5429 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32440-1858
Practice Address - Country:US
Practice Address - Phone:850-263-0639
Practice Address - Fax:850-263-6561
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST FLORIDA HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health