# CRESTVIEW HOSPITAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851570071
- **Authorized official:** JENNIFER L JACKSON (SR DIR ONBOARDING & PROV ENROLLMENT)
- **Authorized official phone:** (615) 465-3334

## Contact information

- **Practice address:** 550 REDSTONE AVE W, SUITE 370, CRESTVIEW, FL 32536-6428
- **Practice address phone:** (850) 423-0061
- **Mailing address:** 7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829
- **Mailing address phone:** (615) 465-7626
- **Mailing address fax:** (615) 465-3007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/25/2007
- **Last updated:** 03/18/2022