Provider Demographics
NPI:1558391771
Name:ASCENSION SACRED HEART EMERALD COAST
Entity Type:Organization
Organization Name:ASCENSION SACRED HEART EMERALD COAST
Other - Org Name:ASCENSION SACRED HEART EMERALD COAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:COBA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:CORNEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-416-6206
Mailing Address - Street 1:7928 SOLUTION CTR
Mailing Address - Street 2:LOCKBOX 777928
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-7009
Mailing Address - Country:US
Mailing Address - Phone:850-278-3199
Mailing Address - Fax:850-416-7453
Practice Address - Street 1:7800 US HIGHWAY 98 W
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7228
Practice Address - Country:US
Practice Address - Phone:850-278-3001
Practice Address - Fax:850-278-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL358425300OtherUSDOL WORKERS COMP
FL592OtherBCBS-FL INSTITUTIONAL
AL010074OtherBCBS-AL INSTITUTIONAL
FL010323300Medicaid
FL358425300OtherUSDOL WORKERS COMP
FL100292Medicare Oscar/Certification