MEDICARE: ASCENSION SACRED HEART GULF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	275N00000X	Medicare Defined Swing Bed Hospital Unit		FL
2	282NR1301X	Rural Acute Care Hospital		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	159	OTHER	FL	BLUE CROSS OF FL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083941678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENSION SACRED HEART GULF

Provider Business Mailing Address
First Line	:	7928 SOLUTION CTR
Second Line	:	LOCKBOX 777928
City	:	CHICAGO
State	:	IL
Zip	:	60677-7009
Country	:	US
Telephone Number	:	850-416-7190
Fax Number	:	850-416-7453

Provider Business Practice Location Address
First Line	:	3801 E HIGHWAY 98
Second Line	:
City	:	PORT ST JOE
State	:	FL
Zip	:	32456-5318
Country	:	US
Telephone Number	:	850-229-5600
Fax Number	:	850-416-7453

Authorized Official
Title or Position	:	COO
Name	:	COBA SUSAN CORNEJO
Credential	:
Telephone Number	:	850-416-6206

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	03/05/2021

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Directions to “ASCENSION SACRED HEART GULF ” Practice Location

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