=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952352304
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SACRED HEART HOSPITAL OF PENSACOLA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2006
-----------------------------------------------------
Last Update Date | 09/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4451 BAYOU BLVD
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32503-2601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-475-4500
-----------------------------------------------------
Fax | 850-475-4781
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2699
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32513-2699
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-475-4738
-----------------------------------------------------
Fax | 850-475-4619
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MS. LAURA IRWIN
-----------------------------------------------------
Credential | FACMPE
-----------------------------------------------------
Telephone | 850-416-6638
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------