Provider Demographics
NPI:1023780269
Name:ASCENSION SACRED HEART GULF
Entity type:Organization
Organization Name:ASCENSION SACRED HEART GULF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE - MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-229-3710
Mailing Address - Street 1:4205 BELFORT RD STE 40105
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3871 E HIGHWAY 98 STE 201
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-5302
Practice Address - Country:US
Practice Address - Phone:850-229-3710
Practice Address - Fax:850-229-3712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty