Provider Demographics
NPI:1336163708
Name:NORTHWEST FLORIDA HEALTHCARE, INC
Entity Type:Organization
Organization Name:NORTHWEST FLORIDA HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
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:850-638-5764
Practice Address - Street 1:1360 BRICKYARD RD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-6303
Practice Address - Country:US
Practice Address - Phone:850-638-1610
Practice Address - Fax:850-638-5764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
FL4005282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010190700Medicaid