Healthcare Provider Details

I. General information

NPI: 1245703453
Provider Name (Legal Business Name): SACRED HEART HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4435 HIGHWAY 90
PACE FL
32571-2066
US

IV. Provider business mailing address

PO BOX 2699
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-5205
  • Fax: 850-416-5204
Mailing address:
  • Phone: 850-416-5205
  • Fax: 850-416-5204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEAN VALLIER
Title or Position: DIRECTOR MANAGED CARE
Credential:
Phone: 904-450-6004