Provider Demographics
NPI:1902857352
Name:SACRED HEART HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:SACRED HEART HEALTH SYSTEM, INC.
Other - Org Name:ASCENSION MEDICAL GROUP SACRED HEART SUB SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-450-6004
Mailing Address - Street 1:5225 CARMEL HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8715
Mailing Address - Country:US
Mailing Address - Phone:850-475-4620
Mailing Address - Fax:850-475-4619
Practice Address - Street 1:5225 CARMEL HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8715
Practice Address - Country:US
Practice Address - Phone:850-475-4620
Practice Address - Fax:850-475-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4142Medicare PIN