Organization
CRESTVIEW HOSPITAL CORPORATION
Active
Organization
CRESTVIEW HOSPITAL CORPORATION
Active
Other names
Crestview Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DIR ONBOARDING & PROV ENROLLMENT)
(615) 465-3334
Entity
Organization
Contact information
Practice address
400 REDSTONE AVE W, CRESTVIEW, FL 32536-8467
(850) 689-8100
Mailing address
PO BOX 198002, ATLANTA, GA 30384-8002
(850) 689-8100
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
4298
FL
261QA1903X
Ambulatory Surgical Clinic/Center
4298
FL
Other
Enumeration date
05/30/2007
Last updated
03/18/2022
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