NPIMap

Organization Active NPI

Calhoun-Liberty Hospital Association Inc

Doing business as Calhoun-Liberty Primary Care Clinic

  • Primary Care Clinic/Center
  • Blountstown, FL
National Provider Identifier
1588944334
Registry record updated Sep 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
HCC680 Issued in FL
Legal business name
CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC
Doing business as
Calhoun-Liberty Primary Care Clinic
Practice address
20370 NE Burns Ave
Blountstown, FL 32424-1045
Phone
(850) 237-3000
Fax
(833) 449-4135
NPI assigned
Aug 25, 2011
Last updated
Sep 4, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2026

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

Authorized official

Name
Emily Marlo Brown
Title
Chief Executive Officer
Phone
(850) 674-5411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X HCC680 FL Primary

Addresses

Primary practice location

20370 NE Burns Ave
Blountstown, FL 32424-1045

Mailing address

16257 State Road 71 S
Blountstown, FL 32424-2808
Phone (850) 237-3000

Other names 1

  • Calhoun-Liberty Primary Care Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20111025000774 FL Part B Supplier - Clinic/Group Practice 8820007016 Receives reassigned benefits from 4 practitioners
Practice locations: Blountstown, FL
O20120320000457 FL Part A Provider - Rural Health Clinic 8820007016 Practice locations: Blountstown, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1588944334. Details of each certification follow.

Rural health clinic certification: CCN 103451

Legal name
CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC
Doing business as
CALHOUN-LIBERTY HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 5, 2012
Last certification
Jul 15, 2024
Ownership / control type
2B
Organization structure
OtherNon-profit
Incorporated
Jan 1, 2000 in FL
Enrollment address
20370 NE Burns Ave
Blountstown, FL 32424-1045
Related CCNs
101304

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Calhoun-Liberty Hospital3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

16257 State Road 71 S
Blountstown, FL 32424
Phone (850) 674-5411

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Mary Sue Neves Individual Corporate DirectorBoard Member Jan 1, 2018
Christinia I Jepsen Individual Contracted Managing EmployeeCeo Oct 19, 2020
Corporate OfficerCeo Oct 19, 2020 100%
James M Wood Individual Corporate OfficerCfo Jul 1, 2022
Melba Anne Faurot Individual Corporate DirectorBoard Member Oct 1, 2017
Laban Bontrager Individual Corporate DirectorBoard Member Jan 1, 2006
Marilyn Russell Individual Corporate DirectorBoard Member Jan 1, 2006
Laddie Williams Individual Corporate DirectorBoard Member Jan 1, 2006
John Tomlinson Individual Corporate DirectorBoard Member Jan 1, 2006
Harrel Tim Revell Individual Corporate DirectorBoard Member Jan 1, 2017
Terry Eubanks Individual Corporate DirectorBoard Member Jan 1, 2018
Mark Plummer Individual Corporate DirectorChairman of the Board Jan 1, 2006

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Calhoun Liberty HospitalBlountstown, FL, CCN 10Z304 Hospital Operational/Managerial Control (100%) Dec 20, 2005

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1314230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788480000000",
    "number": "1588944334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16257 STATE ROAD 71 S",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "324242808",
            "telephone_number": "850-237-3000",
            "fax_number": "833-449-4135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20370 NE BURNS AVE",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "324241045",
            "telephone_number": "850-237-3000",
            "fax_number": "833-449-4135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-25",
        "last_updated": "2026-09-04",
        "certification_date": "2026-09-04",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "EMILY",
        "authorized_official_middle_name": "MARLO",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "850-674-5411"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "HCC680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Calhoun-Liberty Primary Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blountstown, FL

Sources for this page

Verify at the official NPI Registry.