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General NPI Number Information
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NPI Number | 1073285318
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Entity Type | Organization
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Legal Business Name | SACRED HEART MEDICAL GROUP
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 7720 US HIGHWAY 98 W STE 230&260
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-7230
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Country | US
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Telephone | 850-278-3742
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Fax | 850-278-3753
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Provider Business Mailing Address
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Address Line | 4205 BELFORT RD STE 4015
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City | JACKSONVILLE
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State | FL
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Zip | 32216-3623
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR-MANAGED CARE
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Name | JEAN VALLIER
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Credential |
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Telephone | 850-278-3742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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