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NPI Code Detail

MEDICARE: THE SURGERY CENTER AT SACRED HEART MEDICAL PARK, DESTIN, LLC

MEDICARE: THE SURGERY CENTER AT SACRED HEART MEDICAL PARK, DESTIN, LLC
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
1261QA1903XAmbulatory Surgical Clinic/Center1182FL

General Provider Information

NPI Number : 1639164916
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE SURGERY CENTER AT SACRED HEART MEDICAL PARK, DESTIN, LLC
Provider Business Mailing Address
First Line : 36500 EMERALD COAST PKWY
Second Line :
City : DESTIN
State : FL
Zip : 32541-4713
Country : US
Telephone Number : 850-269-0301
Fax Number : 850-269-0203
Provider Business Practice Location Address
First Line : 36500 EMERALD COAST PKWY
Second Line :
City : DESTIN
State : FL
Zip : 32541-4713
Country : US
Telephone Number : 850-269-0301
Fax Number : 850-269-0203
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. DEBORAH N MEIER
Credential :
Telephone Number : 850-269-0301
Provider Enumeration Date : 09/13/2005
Last Update Date : 02/25/2011

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