NPIMap

Organization Active NPI

North Okaloosa Clinic Corporation

  • Family Medicine Physician
  • Brentwood, TN
National Provider Identifier
1235132879
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTH OKALOOSA CLINIC CORPORATION
Practice address
330 Franklin Rd
Brentwood, TN 37027-3280
Phone
(615) 309-3300
Fax
(615) 309-3338
NPI assigned
May 27, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ms. Jennifer Jackson
Title
Senior Director Provider Enrollment
Phone
(615) 465-3334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X FL Primary

Addresses

Primary practice location

330 Franklin Rd
Brentwood, TN 37027-3280

Mailing address

330 Franklin Rd
Brentwood, TN 37027-3280
Phone (615) 309-3300

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.

NPI Registry JSON

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1235132879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 FRANKLIN RD",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370273280",
            "telephone_number": "615-309-3300",
            "fax_number": "615-309-3338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 FRANKLIN RD",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370273280",
            "telephone_number": "615-309-3300",
            "fax_number": "615-309-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH OKALOOSA CLINIC CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-27",
        "last_updated": "2022-07-21",
        "certification_date": "2022-03-18",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "SENIOR DIRECTOR PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "615-465-3334",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brentwood, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.