Provider Demographics
NPI:1861441057
Name:CRESTVIEW HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:CRESTVIEW HOSPITAL COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR, ONBOARDING & PROV ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9815
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-628-6038
Mailing Address - Fax:615-628-6832
Practice Address - Street 1:151 E REDSTONE AVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5352
Practice Address - Country:US
Practice Address - Phone:850-689-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X
FL208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267192100Medicaid
FL34833OtherBCBS
FL40043OtherBCBS
FL40043AOtherBCBS
FL660058100Medicaid
FL660058101Medicaid
AL529921440Medicaid
FL660049202Medicaid
FL660049201Medicaid
FL34833OtherBCBS
FLCC5800Medicare PIN
FL660058101Medicaid
FL660049202Medicaid
FL33565Medicare PIN
FL33565EMedicare PIN