NPIMap

Organization Active NPI

Northwest Florida Healthcare, Inc.

Doing business as Vernon Clinic-NFCH

  • General Practice Physician
  • Vernon, FL
National Provider Identifier
1912287939
Registry record updated Jan 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
4005 Issued in FL
Legal business name
NORTHWEST FLORIDA HEALTHCARE, INC.
Doing business as
Vernon Clinic-NFCH
Practice address
3250 Main St
Vernon, FL 32462-2223
Phone
(850) 535-2096
NPI assigned
Aug 22, 2011
Last updated
Jan 13, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2012

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

Authorized official

Name
Kathy Mitchell
Title
Business Office Supervisor
Phone
(850) 415-8184

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 4005 FL Primary

Addresses

Primary practice location

3250 Main St
Vernon, FL 32462-2223

Mailing address

3250 Main St
Vernon, FL 32462-2223
Phone (850) 535-2096

Other names 1

  • Vernon Clinic-NFCH Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050627000512 FL Part B Supplier - Clinic/Group Practice 2668363771 Receives reassigned benefits from 66 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chipley, FL; Vernon, FL; Marianna, FL; Graceville, FL; Bonifay, FL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Northwest Florida Healthcare Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

1410 Brickyard Rd
Chipley, FL 32428
Phone (850) 638-3400

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1313971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326412800000",
    "number": "1912287939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3250 MAIN ST",
            "city": "VERNON",
            "state": "FL",
            "postal_code": "324622223",
            "telephone_number": "850-535-2096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 MAIN ST",
            "city": "VERNON",
            "state": "FL",
            "postal_code": "324622223",
            "telephone_number": "850-535-2096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST FLORIDA HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-22",
        "last_updated": "2012-01-13",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "BUSINESS OFFICE SUPERVISOR",
        "authorized_official_telephone_number": "850-415-8184"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "4005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vernon Clinic-NFCH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vernon, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.