MEDICARE: PENSACOLA HEALTH TRUST INC

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	314000000X	Skilled Nursing Facility	617	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598757924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENSACOLA HEALTH TRUST INC

Provider Business Mailing Address
First Line	:	2 N PALAFOX ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32502-5631
Country	:	US
Telephone Number	:	850-430-0000
Fax Number	:	850-436-6766

Provider Business Practice Location Address
First Line	:	3401 MAIN ST
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39563-5101
Country	:	US
Telephone Number	:	228-762-7451
Fax Number	:	228-769-2294

Authorized Official
Title or Position	:	CEO PRESIDENT
Name	:	SCOTT J BELL
Credential	:
Telephone Number	:	850-430-0000

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	08/22/2020

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