Organization
CRESTVIEW HOSPITAL CORPORATION
Active
Other names
Gateway Medical Clinic
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
127C E. REDSTONE AVE, CRESTVIEW, FL 32539-5356
(850) 423-0061
Mailing address
330 FRANKLIN RD # 135A-316, BRENTWOOD, TN 37027-3280
(615) 465-7000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Enumeration date
05/05/2006
Last updated
03/18/2022
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