Healthcare Provider Details

I. General information

NPI: 1619494366
Provider Name (Legal Business Name): SACRED HEART HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5147 N 9TH AVE STE 103
PENSACOLA FL
32504-8770
US

IV. Provider business mailing address

PO BOX 2699 ATTN: HPE
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-1900
  • Fax: 850-416-1911
Mailing address:
  • Phone: 850-475-4620
  • Fax: 850-475-4619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number StateFL

VIII. Authorized Official

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