Healthcare Provider Details

I. General information

NPI: 1982963344
Provider Name (Legal Business Name): ASCENSION SACRED HEART GULF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 AVENUE 'E'
APALACHICOLA FL
32320-1763
US

IV. Provider business mailing address

PO BOX 2699
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-370-1000
  • Fax: 850-370-1006
Mailing address:
  • Phone: 850-475-4686
  • Fax: 850-475-4619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA HEMM
Title or Position: ENROLLMENT MANAGER
Credential:
Phone: 904-450-6004