Gateway Medical Clinic Defuniak

LBN: Crestview Hospital Corporation
Gateway Medical Clinic Defuniak is an health care organization with primary practice located at 650 Us Highway 331 S Ste. 4, Defuniak Springs FL 32435-3349. The organization recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Internal Medicine, Ambulatory Health Care Facilities / Rural Health. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty. Crestview Hospital Corporation can be contacted via phone (850) 892-3366, or through Jackson, Jennifer L via phone (615) 465-3334.

Contact Information

Primary practice address
650 Us Highway 331 S Ste. 4 Defuniak Springs FL 32435-3349
Phone: (850) 892-3366
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Jackson, Jennifer L
Phone: (615) 465-3334

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X
Ambulatory Health Care Facilities / Rural Health 261QR1300X

Profile Details

NPI number 1902854425
LBN Legal business name Crestview Hospital Corporation
DBA Doing business as Gateway Medical Clinic Defuniak
Authorized official Jackson, Jennifer L
Entity Organization
Organization subpart 1 Yes
Enumeration date May 5th, 2006
Last updated Mar 18th, 2022 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902854425 NPPES
Florida MEDICAID 660058101
Florida Other 40043A

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