Basic Information
| Provider Information | |||||||||
| NPI: | 1922032424 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SACRED HEART HEALTH SYSTEM, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SACRED HEART HOSPITAL | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7928 SOLUTION CTR | ||||||||
| Address2: | LOCKBOX 777928 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606777009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504167000 | ||||||||
| FaxNumber: | 8504166119 | ||||||||
| Practice Location | |||||||||
| Address1: | 5151 N 9TH AVE | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504167000 | ||||||||
| FaxNumber: | 8504166119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 06/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | CORNEJO | ||||||||
| AuthorizedOfficialFirstName: | COBA | ||||||||
| AuthorizedOfficialMiddleName: | SUSAN | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 8504166206 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SACRED HEART HEALTH SYSTEM, INC. | ||||||||
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| NPICertificationDate: | 06/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 010020 | 01 | AL | BCBS-AL INSTITUTIONAL | OTHER | 403 | 01 | FL | BCBS-FL INSTITUTIONAL | OTHER | HOS0025P | 05 | AL | MEDICAID | 010076500 | 05 | FL | MEDICAID | 126095800 | 01 | FL | USDOL WORKERS COMP | OTHER | 5000183 | 01 | FL | UHC INSTITUTIONAL | OTHER |