NPIMap

Organization Active NPI

Florida Department of Health

Doing business as Walton Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Defuniak Springs, FL
National Provider Identifier
1164775870
Registry record updated Apr 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FLORIDA DEPARTMENT OF HEALTH
Doing business as
Walton Community Health Center
Practice address
362 State Highway 83
Defuniak Springs, FL 32433-1733
Phone
(850) 892-8040
Fax
(850) 892-8024
NPI assigned
Oct 18, 2012
Last updated
Apr 17, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
FLORIDA DEPARTMENT OF HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 17, 2026

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

Authorized official

Name
Jamie Carmichael
Title
Operations & MGMT Consultant MGR -
Phone
(850) 401-6334

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

362 State Highway 83
Defuniak Springs, FL 32433-1733

Mailing address

362 State Highway 83
Defuniak Springs, FL 32433-3800
Phone (850) 892-8040

Other names 1

  • Walton Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131105001970 FL Part A Provider - Federally Qualified Health Center (FQHC) 3072424282 Practice locations: Defuniak Springs, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164775870. Details of each certification follow.

Federally qualified health center certification: CCN 101136

Legal name
FLORIDA DEPARTMENT OF HEALTH
Doing business as
WALTON COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 5, 2013
Last certification
Nov 5, 2013
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
362 State Highway 83
Defuniak Springs, FL 32433-1733

National Provider Directory

National Provider Directory
Tax ID family
Agape Community Health185 organizations share this tax ID, including this one
Part of
Agape Community Health

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Holly Holt Individual Corporate Director Mar 19, 2013
W-2 Managing EmployeeAdministrator Oct 12, 2012 100%
Florida Department of Health Organization, Defuniak Springs, FL Operational/Managerial Control Sep 7, 2010 100%
Jamie Carmichael Individual W-2 Managing EmployeeBusiness Manager II Apr 30, 2018
Operational/Managerial Control Apr 30, 2018
Dennis Edward Hollingsworth Individual Corporate Officer Jan 8, 2021
W-2 Managing Employee Jan 8, 2021

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Bradford Community Health Care IncStarke, FL, CCN 101182 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2013

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776384000000",
    "number": "1164775870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "362 STATE HIGHWAY 83",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324333800",
            "telephone_number": "850-892-8040",
            "fax_number": "850-892-8024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "362 STATE HIGHWAY 83",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324331733",
            "telephone_number": "850-892-8040",
            "fax_number": "850-892-8024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA DEPARTMENT OF HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FLORIDA DEPARTMENT OF HEALTH",
        "enumeration_date": "2012-10-18",
        "last_updated": "2026-04-17",
        "certification_date": "2026-04-17",
        "status": "A",
        "authorized_official_last_name": "CARMICHAEL",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "OPERATIONS & MGMT CONSULTANT MGR -",
        "authorized_official_telephone_number": "850-401-6334"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walton Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Defuniak Springs, FL

Sources for this page

Verify at the official NPI Registry.