1205384336 NPI number — SACRED HEART HEALTH SYSTEM, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205384336 NPI number — SACRED HEART HEALTH SYSTEM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SACRED HEART HEALTH SYSTEM, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1205384336
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1549 AIRPORT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32504-8633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-416-1200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1549 AIRPORT BLVD
Provider Second Line Business Practice Location Address:
200A
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32504-8633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
840-416-4600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HEMM
Authorized Official First Name:
MIRANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
ENROLLMENT MANAGER
Authorized Official Telephone Number:
904-450-6004

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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