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NPI Code Detail

MEDICARE: SACRED HEART MEDICAL GROUP

MEDICARE: SACRED HEART MEDICAL GROUP
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
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1124799069
Entity Type Code : Organization
Provider Name (Legal Business Name) : SACRED HEART MEDICAL GROUP
Provider Business Mailing Address
First Line : 4205 BELFORT RD STE 4015
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-3623
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 281 HIGHWAY 20 E
Second Line :
City : FREEPORT
State : FL
Zip : 32439-3929
Country : US
Telephone Number : 850-835-1235
Fax Number : 850-835-4195
Authorized Official
Title or Position : ENROLLMENT MANAGER
Name : MIRANDA HEMM
Credential :
Telephone Number : 850-835-1235
Provider Enumeration Date : 09/21/2021
Last Update Date : 09/21/2021

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Directions to “SACRED HEART MEDICAL GROUP ” Practice Location

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