Provider Demographics
NPI:1437271509
Name:DOCTORS MEDICAL CENTER OF WALTON COUNTY PA
Entity Type:Organization
Organization Name:DOCTORS MEDICAL CENTER OF WALTON COUNTY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:850-892-2888
Mailing Address - Street 1:21 W. MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435
Mailing Address - Country:US
Mailing Address - Phone:850-892-2888
Mailing Address - Fax:850-892-2405
Practice Address - Street 1:21 W MAIN AVE
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-2529
Practice Address - Country:US
Practice Address - Phone:850-892-2888
Practice Address - Fax:850-892-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS007047261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6600147200Medicaid
FL6600147200Medicaid
FLK0604Medicare PIN