Provider Demographics
NPI:1326094848
Name:SACRED HEART HOSPITAL ON THE EMERALD COAST
Entity Type:Organization
Organization Name:SACRED HEART HOSPITAL ON THE EMERALD COAST
Other - Org Name:SACRED HEART MEDICAL GROUP AT CRESTVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HPE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-475-4620
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:HEALTHPLAN ENROLLMENT
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-475-4620
Mailing Address - Fax:850-475-4619
Practice Address - Street 1:4451 BAYOU BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2601
Practice Address - Country:US
Practice Address - Phone:850-475-4500
Practice Address - Fax:850-475-4781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCK9324OtherRAILROAD GROUP PTAN
FLCK9324OtherRAILROAD GROUP PTAN