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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
1208000000XPediatrics Physician

General Provider Information

NPI Number : 1598431330
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 : 185 CROSSVILLE ST
Second Line :
City : CANTONMENT
State : FL
Zip : 32533-6586
Country : US
Telephone Number : 850-416-7724
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : JEAN VALLIER
Credential :
Telephone Number : 850-416-7724
Provider Enumeration Date : 08/20/2021
Last Update Date : 08/20/2021

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Directions to “SACRED HEART MEDICAL GROUP ” Practice Location

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