Provider Demographics
NPI:1588404826
Name:SACRED HEART HEALTH SYSTEM, INC.
Entity type:Organization
Organization Name:SACRED HEART HEALTH SYSTEM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:COBA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:CORNEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-416-6206
Mailing Address - Street 1:4501 N DAVIS HWY STE B
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2724
Mailing Address - Country:US
Mailing Address - Phone:850-746-1650
Mailing Address - Fax:850-746-1651
Practice Address - Street 1:4501 N DAVIS HWY STE B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2724
Practice Address - Country:US
Practice Address - Phone:850-746-1650
Practice Address - Fax:850-746-1651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SACRED HEART HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-24
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy