Provider Demographics
NPI:1891312815
Name:SACRED HEART ASC, LLC
Entity Type:Organization
Organization Name:SACRED HEART ASC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:COY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-999-2864
Mailing Address - Street 1:1890 SUMMIT BOULEVARD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503
Mailing Address - Country:US
Mailing Address - Phone:833-419-1325
Mailing Address - Fax:844-853-5049
Practice Address - Street 1:1890 SUMMIT BOULEVARD
Practice Address - Street 2:SUITE 210
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503
Practice Address - Country:US
Practice Address - Phone:833-419-1325
Practice Address - Fax:844-853-5049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical