1558391771 NPI number — ASCENSION SACRED HEART EMERALD COAST

Table of content: (NPI 1558391771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558391771 NPI number — ASCENSION SACRED HEART EMERALD COAST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASCENSION SACRED HEART EMERALD COAST
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ASCENSION SACRED HEART EMERALD COAST
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558391771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7928 SOLUTION CTR
Provider Second Line Business Mailing Address:
LOCKBOX 777928
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-7009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-278-3199
Provider Business Mailing Address Fax Number:
850-416-7453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7800 US HIGHWAY 98 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIRAMAR BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32550-7228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-278-3001
Provider Business Practice Location Address Fax Number:
850-278-3010
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CORNEJO
Authorized Official First Name:
COBA
Authorized Official Middle Name:
SUSAN
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
850-416-6206

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 358425300 . This is a "USDOL WORKERS COMP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 592 . This is a "BCBS-FL INSTITUTIONAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010074 . This is a "BCBS-AL INSTITUTIONAL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 010323300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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