| Crestview Surgery Center | |
|
400 Redstone Ave W Crestview FL 32536-8467 | |
| (850) 689-8100 | |
| Not Available |
| Full Name | Crestview Surgery Center |
|---|---|
| Speciality | Clinic/center |
| Location | 400 Redstone Ave W, Crestview, Florida |
| Authorized Official Name and Position | Jennifer L Jackson (SR DIR ONBOARDING & PROV ENROLLMENT) |
| Authorized Official Contact | 6154653334 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crestview Surgery Center Po Box 198002 Atlanta GA 30384-8002 Ph: (850) 689-8100 | Crestview Surgery Center 400 Redstone Ave W Crestview FL 32536-8467 Ph: (850) 689-8100 |
| NPI Number | 1598966343 |
|---|---|
| Provider Enumeration Date | 05/30/2007 |
| Last Update Date | 03/18/2022 |
| Certification Date | 02/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598966343 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 4298 (Florida) | Primary |
| 261QA1903X | Clinic/center - Ambulatory Surgical | 4298 (Florida) | Secondary |
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