NPIMap

Organization Active NPI

North Okaloosa Clinic Corp

Doing business as North Okaloosa Physician Group- Surgery Specialist

  • Surgery Physician
  • Crestview, FL
National Provider Identifier
1023687993
Registry record updated Sep 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
NORTH OKALOOSA CLINIC CORP
Doing business as
North Okaloosa Physician Group- Surgery Specialist
Practice address
550 Redstone Ave W Ste 410
Crestview, FL 32536-6457
Phone
(850) 306-2188
Fax
(850) 398-8470
NPI assigned
Jun 23, 2021
Last updated
Sep 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kristin Music
Title
Dir Prov Enrollment & Onboarding
Phone
(615) 465-7377

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

550 Redstone Ave W Ste 410
Crestview, FL 32536-6457

Mailing address

PO Box 689022
Franklin, TN 37068-9022
Phone (615) 465-7211

Other identifiers 1

IdentifierTypeStateIssuer
273693415MedicaidFL

Other names 1

  • North Okaloosa Physician Group- Surgery Specialist Doing business as

National Provider Directory

National Provider Directory
Tax ID family
North Okaloosa Clinic Corp12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

550 Redstone Ave W
Ste 410
Crestview, FL 32536
Phone (850) 306-2188

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695340800000",
    "number": "1023687993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "615-465-7211",
            "fax_number": "615-628-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 REDSTONE AVE W STE 410",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325366457",
            "telephone_number": "850-306-2188",
            "fax_number": "850-398-8470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH OKALOOSA CLINIC CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-23",
        "last_updated": "2023-09-22",
        "certification_date": "2023-09-22",
        "status": "A",
        "authorized_official_last_name": "MUSIC",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "DIR PROV ENROLLMENT & ONBOARDING",
        "authorized_official_telephone_number": "615-465-7377"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273693415",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Okaloosa Physician Group- Surgery Specialist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crestview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.