Provider Demographics
NPI:1508451287
Name:HNMJTS2021 PLLC
Entity Type:Organization
Organization Name:HNMJTS2021 PLLC
Other - Org Name:DEFUNIAK ALL-CARE WALKIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:850-520-5357
Mailing Address - Street 1:1424 US HIGHWAY 331 S
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435-3401
Mailing Address - Country:US
Mailing Address - Phone:850-920-1700
Mailing Address - Fax:850-520-5357
Practice Address - Street 1:1424 US HIGHWAY 331 S
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-3401
Practice Address - Country:US
Practice Address - Phone:509-201-7008
Practice Address - Fax:850-520-5357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center