| Organization Name: | NORTHWEST FLORIDA HEALTHCARE, INC. |
| NPI Number: | 1912287939 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KATHY MITCHELL (BUSINESS OFFICE SUPERVISOR) |
| Mailing Address: | 3250 Main St Vernon |
| State: | FL US |
| Postal Code: | 324622223 |
| Phone Number: | 8505352096 |
| Fax Number: | |
| NPI Enumeration Date: | 08/22/2011 |
| NPI Last Update Date: | 01/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 4005 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |