| Organization Name: | HEALTHMARK OF WALTON RURAL HEALTH CLINIC INC |
| NPI Number: | 1013908201 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES A BREWER (CFO) |
| Mailing Address: | 4415 Us Highway 331 S Defuniak Springs |
| State: | FL US |
| Postal Code: | 324356307 |
| Phone Number: | 8509514640 |
| Fax Number: | 8508927079 |
| NPI Enumeration Date: | 11/04/2005 |
| NPI Last Update Date: | 08/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |